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Biomedical subjects

T V McCaffrey

Publications and source records attributed to T V McCaffrey.

At least 109 records · Page 6Linked to original sources
PubMed1983

Sarcoidosis of the nose and paranasal sinuses.

Sarcoidosis is a chronic systemic disease of unknown etiology characterized by non-caseating granulomatous inflammation of various organs. The records of 2319 patients with the diagnosis of sarcoidosis were reviewed to determine the incidence of nasal involvement. Seventeen patients or approximately 1% of the patients with sarcoidosis had histologically proven nasal mucosa involvement. These patients had symptoms of nasal crusting, congestion, epistaxis, pain, or anosmia. The clinical findings in these patients included friable nasal mucosa, nasal polyps, or a characteristic submucosal nodularity. Most patients also had abnormal sinus roentgenograms with either thickening of the sinus mucosa or opacification of the sinuses. Biopsy of the nasal mucosa shows typical non-caseating granulomas, but care must be exercised to exclude other causes of granulomatous inflammation of the nasal mucosa including tuberculosis, fungal infections, and other idiopathic granulomatous diseases such as Wegener's granulomatosis and Churg-Strauss syndrome. The treatment of nasal sarcoidosis has consisted of systemic steroids and in some cases topical beclomethasone dipropionate.

Adolescent↗
PubMed1983

Septic necrosis of the internal carotid artery: a complication of peritonsillar abscess.

Septic necrosis of the internal carotid artery is a major complication of peritonsillar abscess. Although once a common complication, its occurrence is rare since the introduction of antibiotics. A 12-year-old girl was referred to our institution after a false aneurysm of the internal carotid artery had been entered during routine tonsillectomy for a peritonsillar abscess. Review of the literature and features of the present case demonstrate the following findings suggestive of erosion of the internal carotid artery as a result of peritonsillar abscess: (1) spontaneous hemorrhage from a peritonsillar abscess, (2) persistent peritonsillar swelling after resolution of symptoms of peritonsillar abscess, (3) ipsilateral Horner's syndrome, and (4) otherwise unexplained cranial nerve palsies (nerves IX, X, XI, and XII).

Carotid Artery Diseases↗
PubMed1983

Histamine-evoked nasal secretion in the dog.

Nasal secretory activity was measured in seven dogs in response to topical stimulation by histamine and methacholine. The methacholine response was blocked by atropine but not by chlorpheniramine. The histamine response was blocked by chlorpheniramine but not by atropine. These results suggest that there are two independent mechanisms of nasal secretion in the dog.

Animals↗
PubMed1983

Effect of chemoreceptor and pulmonary receptor stimulation on dilator nares EMG activity in the dog.

To define the relationship between central control of upper airway muscles and respiratory muscle function, the electromyographic responses of the dilator nares muscles to stimulation of chemoreceptors and pulmonary receptors were studied in six anesthetized dogs. Only at maximal levels of hypoxia was the inspiratory activity of the dilator nares significantly increased. Hypercapnic stimulation increased the inspiratory activity with each incremental increase in CO2. Pulmonary stretch receptor stimulation produced by lung inflation inhibited dilator nares activity. Pulmonary irritant receptor stimulation by intravenously administered histamine increased dilator nares activity, as did pulmonary J receptor stimulation by the intravenous administration of capsaicin.

Animals↗
PubMed1980

Malignant melanoma of the oral cavity: review of 10 cases.

Oral malignant melanoma is uncommon, comprising less than 1% of all malignant melanomas. Consequently, few cases have been reported from any one institution. We report 10 cases of malignant melanoma of the oral cavity seen at the Mayo Clinic between 1905 and 1979. The site of the primary tumor was the hard palate in 4 patients, the soft palate in 2 patients, the lower alveolus in 2 patients, and the upper alveolus and the retromolar trigone in 1 patient each. Eight of these tumors occurred in men, and 8 patients were older than 60 years of age. Presenting symptoms were a pigmented mass in 9 patients, pain in 5 patients, and bleeding in 3 patients. In 4 patients, the tumor occurred in an area of preexisting hyperpigmentation. The treatment of choice in this disease is surgery; it is the only form of therapy with curative potential. Radiation therapy produced tumor regression in one patient in whom the tumor was considered inoperable, although there was no effect on eventual survival. Chemotherapy was ineffective in producing tumor regression. The prognosis of patients who have malignant melanoma of the oral cavity is dismal; the median survival time in this series was 16 months after diagnosis. Early diagnosis of pigmented lesions in the mouth and adequate tumor resection may improve the prognosis in this disease; however, once the tumor recurs, there is essentially no possibility of prolonged survival.

Adult↗
PubMed1979

Clinical evaluation of nasal obstruction. A study of 1,000 patients.

Nasal airway resistance was evaluated in 1,000 patients who were seen at the Mayo Clinic between 1971 and 1977 for rhinologic complaints. Nasal obstruction was reported as the major symptom in 863 patients. Nasal airway resistance correlated well with the side and the severity of the obstructive symptoms. Symptoms of nasal obstruction typically occurred with a total nasal resistance greater than 3 cm H2O/L/s. Rhinoscopic evidence of nasal deformity could not be used to predict an increase in nasal resistance since many patients with rhinoscopically abnormal noses had "normal" nasal resistances. We conclude that the calculation of nasal airway resistance is a useful technique in the clinical evaluation of nasal obstruction. Nasal airway resistance data provide objective values that can substantiate and quantitate the symptoms of nasal obstruction.

Airway Obstruction↗
PubMed1979

Role of skin temperature in the control of sweating.

In five male subjects tympanic membrane temperature (Tty), rectal temperature, skin temperatures at 12 sites were simultaneously recorded. Local sweating rate was measured at six sites using resistance hygrometry. After steady-state sweating was established, the lower body was heated at ambient temperatures of 50, 60, 70, and 80 degrees C or cooled at an ambient temperature of 29 degrees C while the upper body remained at a constant ambient temperature. During lower body heating or cooling, Tty was maintained constant by the drinking of cold (10 degrees C) or warm (45 degrees C) water. Sweating rate on both upper and lower body surfaces was proportional to lower body skin temperature. The regression coefficients for sweating rate versus mean lower body skin temperature varied from 0.03 to 0.09 mg/cm2.min. degrees C between subjects, but were not significantly different from each other (P greater than 0.05). This study demonstrates an influence of cutaneous thermoreceptors on sweating rate under steady-state conditions.

Humans↗
PubMed1979

Histiocytosis X of the ear and temporal bone: review of 22 cases.

Histiocytosis X encompasses three syndromes characterized by the idiopathic proliferation of histiocytes: eosinophilic granuloma, Hand-Schuller-Christian syndrome, and Letterer-Siwe disease. At the Mayo Clinic between 1926 and 1978, 22 patients with histiocytosis X had involvement of the ear or temporal bone. These patients comprised 15% of all patients with histiocytosis X seen during that period. The ages at onset of the disease ranged from 2 months to 49 years. The most frequent otologic symptom was aural discharge (15 patients), followed in frequency by swelling in the temporal region (11 patients), vertigo (6 patients), and deafness (5 patients). Clinical findings included otitis media (13 patients), otitis externa with or without granulation tissue (10 patients), and osteolytic lesions of the temporal bone (9 patients). A high index of suspicion is required to recognize the otologic manifestations of histiocytosis X for two reasons: the systemic manifestations of the disease are often so dramatic that the ear findings are overlooked, and the otologic findings of histiocytosis X can mimic more common diseases, including simple otitis externa, aural polyps, acute mastoiditis, chronic otitis media, and metastatic lesions.

Adolescent↗
PubMed1977

Management of epistaxis in hereditary hemorrhagic telangiectasia. Review of 80 cases.

Intranasal dermoplasty and estrogen therapy have been shown to be the most effective means of managing epistaxis in patients with hereditary hemorrhagic telangiectasia. In a series of 80 patients studied, the most effective treatment was by intranasal dermoplasty; of 22 patients so treated, 14 had improvement for more than six months after surgery and six had improvement for one to six months. Regrafting for recurrent epistaxis was successful in four of five patients (improvement for more than six months). Estrogen was administered for systemic effect to 16 patients and produced improvement of more than six months' duration in eight and of one to six months' duration in three. Other forms of management were less effective for the prolonged control of epistaxis.

Administration, Topical↗
PubMed1976

Cardiovascular and electrophysiological responses to sympathetic pathway stimulation.

Anesthetized, vagotomized, and paralyzed cats were used to study the relationship between changes in blood pressure and T2 preganglionic nerve activity elicited by stimulation of descending spinal sympathoexcitatory pathways. While low-frequency stimulation (1-10 Hz) resulted in a depressor response, an attenuation of sympathetic nerve evoked discharges was noted after the second pulse of twin-pulse stimulations with 1,000- to 100-ms intervals between stimuli (corresponding to 1-10 Hz). High-frequency stimulation (greater than 10 Hz) resulted in a pressor response, while preganglionic nerve-evoked discharges were enhanced during twin-pulse stimulations with intervals between stimuli less than 50 ms (corresponding to greater than 20 Hz). These data suggest that the depressor response during low-frequency stimulation may be explained by impulses occurring during the silent period of the previous response. During this time the preganglionic neuron is inexcitable and spontaneous activity is abolished; therefore, the blood pressure falls. High-frequency stimulation may result in a pressor response by increasing the number of preganglionic neurons that are activated. This may be due to a process of temporal summation, with initial stimuli bringing cells closer to their threshold for firing and additional stimuli close in time causing these neurons to discharge.

Animals↗
PubMed1975

Effect of head skin temperature on tympanic and oral temperature in man.

Five subjects were sequentially heated and cooled in a double-climate chamber while mean skin temperature (except the head) and head skin temperature were separately varied. The tympanic membrane temperatures of these subjects were disproportionately influenced by changes in head skin temperature. By heating and cooling localized regions of the head, changes in tympanic membrane temperature that followed changes in skin temperature on the ipsilateral side of the head could be produced. During heating of the head, oral and tympanic membrane temperatures were influenced to a similar degree, while esophageal temperature remained essentially unaffected. However, under conditions in which the legs and feet were heated in a water bath, esophageal temperature showed more rapid changes than either tympanic membrane or oral temperature. These findings suggest that tympanic membrane temperature and, to a lesser degree, oral temperature may be affected by thermal exchange occurring between arteries and veins in the cervical and cephalic regions. In addition, the ability to influence selectively esophageal and tympanic membrane temperatures brings into question the arbitrary use of these measurements under widely different experimental conditions as estimates of core temperature.

Body Temperature Regulation↗
PubMed1975

A thermal method for the determination of tissue blood flow.

An isothermal flowmeter for the determination of local tissue blood flow is described. Flow is determined by the measurement of the thermal conductivity of the tissue in the vicinity of a heated thermistor maintained at a fixed temperature difference above a reference thermistor. Direct heating of the thermistor is utilized to eliminate the need for specially constructed indirectly heated thermistors. This design results in a device with a voltage output directly proportional to tissue thermal conductivity and to tissue blood flow. The device is shown to be adequate for the qualitative measurement of myocardial blood flow under various situations. Construction is simplified and the size of the circuit reduced by the use of readily available integrated circuits.

Animals↗
PubMed1975

Effect of isolated head heating and cooling on sweating in man.

A double climate chamber which permitted the independent regulation of temperature in each chamber was used to produce isolated head heating and cooling in three subjects. Deep body temperature was recorded from the tympanic membrane, oral cavity, esophagus, and rectum. Skin temperature was measured on nine body regions and a weighted mean skin temperature was calculated. Sweating rate was measured by resistance hygrometry from six regions. When head skin temperature was increased, deep body temperature measured at the tympanic membrane and oral cavity increased more than esophageal temperature, while rectal temperature remained essentially unchanged. Sweating rate increased when head skin temperature increased and again, somewhat later, as the tympanic membrane and oral temperatures began to rise. When head skin temperature was decreased, tympanic membrane and oral temperatures decreased and sweating again followed the changes in skin temperature as well as the changes in tympanic membrane and oral temperatures. Since it has been shown that head skin temperature is particularly important in determining thermal comfort and sweating rate when compared to other body regions, it is suggested that this particular sensitivity is in part due to a thermal counter-current exchange between venous blood draining the head and arterial blood ascending to intracranial thermoreceptors. Such an exchange would correspond to similar mechanisms present in other species.

Body Temperature↗
PubMedDate not supplied

Locally invasive papillary thyroid carcinoma: 1940-1990.

Well-differentiated thyroid carcinoma infrequently invades the upper aerodigestive tract. However, when invasion occurs, it is the source of significant morbidity. The most common structures invaded by thyroid carcinoma are the recurrent laryngeal nerves, larynx, pharynx, and esophagus. Invasion of these structures produces symptoms of airway insufficiency, dysphagia, and hemoptysis. This study was designed to define more clearly the significance of invasion of papillary thyroid carcinoma on survival. At the Mayo Clinic, 262 patients treated for invasive papillary thyroid carcinoma between 1940 and 1990 were retrospectively evaluated. In this group the sites of invasion were muscle 53%, trachea 37%, laryngeal nerve 47%, esophagus 21%, larynx 12%, and other sites 30%. Complete tumor removal was accomplished in 56% of cases. Kaplan-Meier survival curves were calculated for the population. The overall survival was 79% at 5 years, 63% at 10 years, and 54% at 15 years. When the Cox proportional hazard model was applied to the survival data, the factors that had significant influence on survival were invasion of the trachea and the esophagus. Completeness of resection approached statistical significance. Muscle invasion, laryngeal invasion, and recurrent laryngeal nerve invasion had no significant independent influence on survival. These data suggest that when papillary thyroid carcinoma extends beyond the thyroid capsule and invades adjacent structures, the site invaded will influence survival. Survival may be improved in those cases in which complete surgical excision of the tumor is performed.

Carcinoma, Papillary↗
PubMedDate not supplied

Parapharyngeal space neoplasms.

BACKGROUND: Primary parapharyngeal space neoplasms are rare. Tumor distribution characteristics and long-term outcome have been quite variable in the recent literature. We report the results of a retrospective review of 172 patients with primary parapharyngeal space neoplasms treated surgically from 1960 to 1990 at a large multispecialty clinic and teaching hospital. METHODS: Initially, 195 patients seen at our institution were found to have parapharyngeal space neoplasms. Twenty-three patients previously treated elsewhere were excluded. The remaining 172 patients (96 female and 76 male) were from 11.7 months to 91.5 years of age. All patients were treated surgically; the transparotid-cervical approach was most widely used. RESULTS: One hundred thirty-seven tumors (80%) were benign and 35 (20%) were malignant. High-resolution computed tomography or magnetic resonance imaging was essential in the diagnosis and presurgical planning. Fine-needle aspiration specimens were accurate in the diagnosis of 8 or 9 cases. Pleomorphic adenoma was the most common neoplasm (40%), followed by paraganglioma (20%), neurogenic tumor (14%), malignant salivary gland tumor (13%), miscellaneous malignant tumors (7%), and miscellaneous benign tumors (6%). Mandibulotomy was required for only 6% of all tumors; its use was reserved for malignant lesions and large skull base tumors when risk of tumor rupture was high. Recurrent or persistent disease was recorded in 27 patients with malignant tumors; of these, 24 (89%) are likely to die of disease. CONCLUSIONS: The transparotid-cervical approach is the preferred procedure for most parapharyngeal tumors and can be combined with midline mandibulotomy for large vascular or selected malignant tumors. Recurrence after removal of pleomorphic adenomas is only 4%. Recurrent or persistent malignant disease is nearly always fatal. Perioperative mortality is zero, and morbidity is most often associated with cranial nerve neuropathy.

Adolescent↗
PubMedDate not supplied

Response of nasal airway resistance to hypercapnia and hypoxia in man.

The response of nasal airway resistance (Rn) to various degrees of hypoxia and hypercapnia was measured in six subjects using active posterior mask rhinomanometry. All resistances were computed during expiration at the flow rate of 0.5 liter/sec. Hypercapnia, induced by breathing gas mixtures of various contents of carbon dioxide, significantly decreased Rn (P less than 0.05, Wilcoxon signed rank test). The reduction in Rn was proportional to the inspired partial pressure of carbon dioxide over a range of 0 to 50 torr. Breathing gas mixtures of high and low contents of oxygen produced no significant change in Rn (P less than 0.05, Wilcoxon signed rank test). These results indicate that the nasal airway is actively involved in the respiratory response to hypercapnia but not to moderate hypoxia.

Adult↗