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Biomedical subjects

W H Friedman

Publications and source records attributed to W H Friedman.

At least 37 records · Page 2Linked to original sources
PubMed1988

Lacerations of the cervical trachea in children.

Two case histories of a posterior tracheal laceration in children are presented. Both lacerations were small and well approximated at the time of initial endoscopy, and were managed conservatively. The resolution of signs and symptoms was rapid, and both patients were discharged after 4 days of hospitalization. Blunt trauma to the neck, not uncommon in children, is rarely a cause of cervical tracheal injury. When a tracheal laceration occurs, an immediate tracheostomy is usually recommended. Our experience supports a conservative management of small membraneous cervical trachea lacerations which seem well approximated at the time of endoscopy. Potential morbidity from tracheostomy is avoided, and the patient's hospitalization shortened.

Bicycling↗
PubMed1988

Unilateral sensorineural deafness in children.

Heredity, viral infection, and head or acoustic trauma are considered the common etiologies for a unilateral sensorineural deafness in children. The incidence of perilymphatic fistula in a unilateral hearing loss is still unknown. Inner ear-related symptoms in children are scarce, and little diagnostic laboratory testing is available. A definite diagnosis of a perilymphatic fistula can therefore be made only by an exploratory tympanotomy. Four children, ages 5 to 15 years, with a history of a recent and rapidly progressive unilateral sensorineural hearing loss, were explored. Preoperative laboratory data, which included a fistula test, ENG, CT scan of the temporal bones, and an ABR, were all within normal limits. An overt fistula was found in only one of the patients. Only an exploratory tympanotomy can arrest and possibly reverse a unilateral hearing loss or discontinue a middle ear-cranial cavity communication. It is therefore our feeling that, in patients with an appropriate history, the potential benefit outweighs the risk and morbidity of an exploratory tympanotomy.

Adolescent↗
PubMed1987

The Goldman tip in secondary rhinoplasty.

The ingenious division and suture of the mesial crura of the lower lateral cartilages devised by Goldman has found little utilization in recent years, even by surgeons familiar and experienced with this procedure. However, in secondary rhinoplasty, many of the disadvantages inherent in the Goldman tip can be turned to the surgeon's advantage and used to correct nasal tip defects which might otherwise prove refractory to treatment. Cartilage deficit, tip asymmetry, unacceptable bifidity, excessive tip elevation, hanging columella, and insufficient bulk are readily corrected with the Goldman tip and variations on its basic theme. This report covers the authors' 20-year experience with the Goldman tip, including a recent increase in the utilization of this procedure for secondary rhinoplasty.

Humans↗
PubMed1987

Preoperative computerized tomographic imaging in hyperparathyroidism.

The surgery of hyperparathyroidism can be technically very difficult, even for an experienced surgeon. Until the present decade, preoperative localization procedures were of little help because of poor resolution of imaging modalities, significant morbidity, and the cost of invasive procedures. The efficacy of preoperative high-resolution CT scanning was evaluated in ten patients with primary hyperparathyroidism who had not previously been operated on. Contrast and noncontrast scans were performed on each patient, under the supervision of an experienced radiologist. Surgical findings were the standard against which all CT scans were judged. Each patient was diagnosed as having a single adenoma. Preoperative scans localized eight of ten adenomas for an overall sensitivity of 80 percent. In one patient, the adenoma was incorrectly localized for a specificity of 89 percent. The smallest adenoma correctly localized measured 4 x 4 mm in its axial dimensions. In addition to shortening operative time, accurate preoperative localization permitted use of unilateral dissection technique. Recent literature has repeatedly proved unilateral dissection superior to bilateral dissection by production of identical cure rates and a 2- to 12-fold decrease in postoperative hypocalcemia. We suggest that CT scanning be considered in the routine preoperative workup of patients who have primary hyperparathyroid disease.

Adenoma↗
PubMed1987

Nasopharyngeal complications following uvulopalatopharyngoplasty.

This report presents our experience with nasopharyngeal complications of UPPP in 85 patients undergoing the procedure from May, 1982 to January, 1985. Three patients developed nasopharyngeal stenosis and one patient developed permanent velopharyngeal insufficiency. Surgical management in two patients with nasopharyngeal stenosis resulted in adequate nasopharyngeal airway, while one patient still has a moderate stenosis following two surgical procedures. The patient with velopharyngeal insufficiency underwent Teflon paste injection in the posterior pharyngeal wall. This resulted in complete alleviation of his nasal regurgitation.

Constriction, Pathologic↗
PubMed1986

The degree to which accuracy of preoperative staging of laryngeal carcinoma has been enhanced by computed tomography.

In this retrospective study, the accuracy of preoperative staging by high-resolution CT and clinical evaluation (indirect-direct laryngoscopy) is compared to the postsurgical pathologic staging of laryngeal cancer. Forty-two patients who were admitted to St. Louis University Hospital between the years of 1978 to 1985 with diagnoses of laryngeal cancer were included. All patients received high-resolution CT scan of the larynx preoperatively and subsequently underwent total or partial laryngectomy. None of these patients received preoperative radiotherapy. The accuracy of the clinical vs. CT staging--as well as the accuracy of the staging by combination of the two modalities--was determined by comparison with the postsurgical pathologic staging. The accuracy was assessed separately for glottic, supraglottic, and transglottic carcinoma. The accuracy of CT staging for glottic carcinoma was 75%. However, clinical evaluation in this group of lesions was very reliable, offering 92.9% accuracy. The accuracy of CT staging increased in the supraglottic and transglottic lesions, to become superior to the clinical staging. With combined information gained by both examinations, the preoperative staging accuracy was 91.4% for supraglottic carcinoma and 87.5% for transglottic carcinoma. It is, therefore, recommended that high-resolution CT should be included in the preoperative staging of laryngeal cancer.

Carcinoma↗
PubMed1986

Sphenoethmoidectomy: the case for ethmoid marsupialization.

The authors report 510 sphenoethmoidectomies performed on 255 patients between 1969 and 1985. An overall polyp recurrence rate of 19.2% and less than a 1% complication rate are reported during that time. In patients followed jointly by the otolaryngologists and allergist, including 374 consecutive sphenoethmoidectomies on 187 patients who had this operation performed by the senior author, there was an overall polyp recurrence rate of 15% and a complication rate which was again less than 1%. Recent improvements in recurrence rates and diminished complication rates are attributed to better visualization and adherence to the concept of complete exenteration or marsupialization of the ethmoid labyrinth including middle turbinate resection in every case. Cooperation between the otolaryngologist and allergist is stressed, along with the realization that pulmonary and sinus diseases are frequently interrelated and may both be benefited by the performance of sphenoethmoidectomy in the patient with hyperplastic rhinosinusitis.

Allergy and Immunology↗
PubMed1985

Contralateral laryngoplasty. An update on reconstruction of the larynx following supraglottic laryngectomy with vertical extension.

Twenty patients with supraglottic carcinoma extending onto an arytenoid or true vocal cord underwent supraglottic laryngectomy with vertical extension that included the resection of an arytenoid. In these patients, the contralateral superior thyroid cornu was used to reconstruct the resulting defect. In this technique, the thyroid cornu is mobilized and greenstick fractured across the posterior commissure, thus maintaining its blood supply by leaving the inferior and middle pharyngeal constrictor muscles attached. This muscle-cartilage pedicle provides bulk for the posterior glottis and can be anchored anteriorly to form a new hemilarynx. This reconstruction has provided excellent anteroposterior diameter and bulk in the laryngeal remnant, resulting in preservation of airway and voice and prevention of aspiration comparable with that achieved following supraglottic laryngectomy without vertical extension or resection of an arytenoid. It is a reliable technique for reconstructing extended laryngeal defects and is herein presented with long-term follow-up.

Adult↗
PubMed1985

Further evaluation of uvulopalatopharyngoplasty in the treatment of obstructive sleep apnea syndrome.

Since its introduction in 1981 uvulopalatopharyngoplasty (UPPP) has become an alternative surgical approach to permanent tracheostomy in treating obstructive sleep apnea (OSA). However, the criteria for selecting candidates for this procedure are unclear and the prediction of a positive response remains an enigma. This article presents the experience with UPPPs performed on 35 patients who had moderate to severe OSA. Criteria for patient selection included apnea severity, cardiopulmonary sequelae, and clinical symptomatology. All but two patients demonstrated clinical improvement, although there was considerable variability in the degree of response. Patients were classified as good or poor responders on the basis of the severity index (SI), which represents the number of apneas and hypopneas per hour of sleep resulting in oxygen saturation below 85%. A greater than 50% improvement in the SI was considered a good response. Twenty-three patients (65.7%) were good responders and the remaining 12 (34.3%) were poor responders. The need for permanent tracheostomy was obviated in 16 of 32 patients presenting with disabling daytime sleepiness or severe cardiopulmonary sequelae. Therefore it appears that UPPP is useful for treating most OSA patients.

Adult↗
PubMed1985

Oncogenes in laryngeal cancer: serial passage of transformed cellular DNA.

DNA originally extracted from squamous cell cancer of the larynx has been serially passaged through transformed populations of NIH/3T3 mouse fibroblasts. The transformed foci were then harvested, cloned to volume, and incubated with a fresh population of NIH/3T3 cells in a second passage. Transforming efficiencies were enhanced by serial passage. In addition, Southern Blot analysis of the transformed foci revealed hybridization between transformant DNA and human probe DNA from the Alu family of conserved human DNA sequences. In the first passage this hybridization took the form of diffuse homology throughout the entire molecular weight distribution. The second-passage DNA showed "narrow bands" indicating the possibility that an oncogene has been identified in laryngeal cancer and that serial passage has eliminated contaminating human sequences. Repetitive transfection in third- and fourth-passage studies is now being completed.

Animals↗
PubMed1985

Oncogenes: their presence and significance in squamous cell cancer of the head and neck.

DNA extracted from squamous cell carcinomas of the larynx and tongue has been shown to contain cellular transforming genes characterized by their ability to transform mouse fibroblasts into malignant foci of cells which, when subsequently cloned and grown to volume, have been found to contain human DNA sequences. This DNA has been serially passaged through subsequent populations of NIH/3T3 mouse fibroblasts. Higher malignant transformation efficiencies have been observed and reported with serial passage. Of greater significance is the repeated identification of oncogenes of identical characteristics on electrophoretic radioisotope analysis.

Carcinoma, Squamous Cell↗
PubMed1983

Reconstruction of the paralyzed face with the polypropylene mesh template.

Several techniques for static suspension of soft tissues in facial paralysis are available, including this use of the polypropylene (Marlex) mesh template. Through a standard rhytidectomy, lip and melolabial incisions, this template can be attached to the pivotal facial suspension points to bring about a selective and adjustable redistribution of the facial soft tissues. Although not meant to replace autogenous tissue use or physiologic reanimation procedures, this technique proved to be useful in three selective cases. The functional and cosmetic consequences of the polypropylene mesh template insertion on both a model and on three clinical patients with unilateral facial paralysis illustrate this technique. The concept of facial suspension along with its limitations, especially as it relates to template use and static facial suspension, are discussed.

Adult↗
PubMed1983

Current management of cerebrospinal fluid rhinorrhea.

Forty-two patients with cerebrospinal fluid (CSF) rhinorrhea presenting over a 5 year period were analyzed as to age, sex, etiology, anatomical and clinical findings, and methods of investigation and treatment. Eighty-eight were traumatic in origin, with the most common anatomical sites being ethmoid, frontal and sphenoid sinuses, and the cribriform plate region. Meningitis and pneumocephalus were the most frequently associated clinical findings each present in 31% of the cases. Chemical analysis of the CSF for protein was positive in 88% of cases vs. 13% when the protein content was quantitatively analyzed. The demonstration and localization of CSF leaks were most effective using metrizamide and CAT scanning when they were active and by indium cisternography when they were small, intermittent, or questionable. The clinical management was divided into medical and surgical approaches with the advantages and disadvantages discussed.

Adolescent↗
PubMed1983

Oncogenes: preliminary studies in head and neck cancer.

DNA has been extracted from squamous cell carcinomas of the larynx, base of tongue, and nasopharynx. These tumors were excised from patients at the St. Louis University Medical Center and processed at the Institute for Molecular Virology of the St. Louis University Medical Center. NIH/3T3 cells were transfected with the DNAs from these cancers. Malignant, transformed foci of NIH/3T3 cells have been observed. These foci have been cloned and grown in quantity. The cloned foci have been injected into nude mice with the production of highly malignant sarcomas. DNA extracted from these sarcomas has shown homology with human DNA on hybridization analyses of both nasopharynx and tongue cancer. Further hybridization studies are being conducted on the larynx cancer-induced sarcomas and on the DNAs taken from the original transformed foci of NIH/3T3 cells transfected with squamous cell cancers of the larynx, nasopharynx, and tongue base. Our preliminary results indicating the presence of human sequences in the mouse sarcomas support the hypothesis that human cellular transforming gene(s) may be present in the DNA isolated from the head and neck cancers. Additional studies will include repetitive retransfection of NIH/3T3 cells, molecular cloning of putative oncogenes, and DNA sequence analysis of the cloned oncogenes. It is hoped that identification of putative oncogene sequences will result in the identification of the proteins coded for by the specific nucleotide sequences responsible for malignant cellular transformation by DNA extracted from head and neck tumors.

Animals↗
PubMed1982

Dynamic compression plating in the treatment of mandibular fractures. Early experience.

The production of rigid fracture fixation has most recently been carried out by the use of internal compression plates. These allow for a simple and accurate method of providing either static or dynamic osteosynthesis in a variety of maxillofacial applications. Especially in cases involving the edentulous mandible, in comminuted fractures with or without loss of bone, in fractures where intermaxillary fixation would be necessary, or when internal splinting is required, this technique as presented may offer some unique and desirable advantages. An overview of the general principles and technique is presented and discussed.

Adolescent↗