Biomedical subjects
Publications and source records attributed to W J Goodwin.
A technique is presented whereby a median mandibulotomy of an atrophic edentulous mandible is performed to gain access to an oropharyngeal tumor and is subsequently reapproximated with a four-pin FMI. The procedure allows reduction of the osteotomy site and provides intraoral implants that increase the stability and retentive properties of a mandibular prosthesis.
This retrospective study looked at the role of indium 111-labeled white blood cell (111In WBC) scintigraphy in head and neck infections. The efficacy of 111In WBCs was compared to gallium 67 citrate (67Ga) and technetium Tc99m methylene diphosphonate (99mTc MDP) scintigraphy in detecting and monitoring the resolution of infection. For 22 active infections, the sensitivities for 111In WBC, 67Ga, and 99mTc MDP scintigraphy were 94%, 56%, and 86%, respectively, and the specificities for 111In WBC, 67Ga, and 99mTc MDP scintigraphy were 100%, 43%, and 0%, respectively. For 8 successfully treated infections, all seven 111In WBC studies became negative after therapy, in as short an interval as 1 month. In contrast, all seven 99mTc MDP images remained positive for as long as 6 months after therapy. The seven 67Ga studies had variable results, with four (57%) remaining positive, including two (28%) positive at 6 months after therapy. These results suggest that 111In WBC scintigraphy should be the initial radionuclide imaging tool in detecting active head and neck infections because of its greater accuracy, and its ability to revert to normal much sooner than 67Ga or 99mTc MDP scintigraphs when applied to a subset of patients with resolved infections.
Open node biopsy was the method of choice for diagnosing human immunodeficiency virus (HIV) infection before serologic testing became available. Currently, the otolaryngologist is often called on to assist in the management of HIV-positive patients with troublesome cervical adenopathy. Today's questions are: what is the place of fine-needle aspiration (FNA), and when is open cervical node biopsy indicated. A retrospective review was undertaken of 93 consecutive cervical node biopsies performed by our department during the 5-year period from 1985 to 1989. Twenty of the patients who underwent biopsy were HIV-positive. Of these twenty, ten carried an established diagnosis of acquired immune deficiency syndrome (AIDS). Seventeen of these patients underwent FNA before biopsy. In the eight patients with persistent generalized lymph-adenopathy (PGL) and nontender, nonenlarging nodes, pathologic analysis revealed lymphoid hyperplasia. Five of these patients had antecedent FNA, none demonstrating any pathologic changes. Of the twelve patients with enlarging or tendon nodes, the diagnosis of mycobacterial adenitis was made in eight, Nocardial infection in two, Burkitt's lymphoma in one, and metastatic Kaposi's sarcoma in one. In four of the patients diagnosed with mycobacterial infections, FNA yielded cytologic evidence of acid-fast bacilli and open lymph node biopsy added nothing. In contrast, FNA failed to reveal the diagnosis in both patients with Nocardial infection, and in the two patients with neoplastic disease. We conclude that cervical node biopsy is not indicated in the HIV or AIDS patient with nontender or nonenlarging nodes.(ABSTRACT TRUNCATED AT 250 WORDS)
To evaluate the clinical value of two serologic tumor markers, squamous cell carcinoma-associated antigen and plasma lipid-bound sialic acid, for identifying cancers of the head and neck, plasma specimens were obtained from patients receiving care for untreated newly diagnosed cancers of the head and neck, routine surveillance for recurrence, or treatment for chronic nonmalignant otolaryngologic conditions. Using identical methods at two institutions, levels of both markers were determined blind to diagnoses for patients with biopsy-proven cancers of the head and neck (n = 134) and for those defined as cancer free based on clinical evaluation for 6 months (n = 140). Disease status was determined blind to tumor marker level results. Cancer prevalence was 48.9%. Applying standard normal limits used alone, plasma lipid-bound sialic acid test sensitivity was 63.4% and specificity was 77.9%. For squamous cell carcinoma-associated antigen alone, test sensitivity was 27.6% and specificity was 85.0%. Neither test alone appears sensitive enough to effectively detect early cancers of the head and neck. When the results of both tests in series combination were positive, sensitivity was 18.7% and specificity was 95.0%. If either was positive in parallel combination, sensitivity was 72.4% and specificity was 68.0%. Further evaluation is required that applies different definitions of normal and determines longitudinal changes with disease status.
Laryngeal trauma often results in impaired laryngeal physiology, and may result in severe dysphonia. Effective rehabilitation requires the utilization of sophisticated diagnostic and surgical methods.
Horizontal osteotomy allows the surgeon to safely down-fracture the maxilla for wide exposure of the central skull base. This surgical approach is easily extended posteriorly in the midline to include the clivus and the arch of C1, providing 8 cm of horizontal anterior exposure and 5 cm of posterior. Wide operative exposure and a low rate of complications afford superior functional and cosmetic preservation in removing tumors of the central cranial base.
Nineteen cases of intracranial abscesses secondary to infection of the midface are reported. The most common underlying cause was bacterial sinusitis. Other etiologic factors included mucormycosis following steroid therapy, Wegener's granulomatosis, nasal dermoid cyst and sinus tract, tooth abscesses, aspergillosis following chemotherapy for leukemia, squamous cell carcinoma of the frontal sinus, infected methylmethacrylate plate for a prior skull fracture, and a case of gauze packing left in the sinus following surgery. Anaerobic organisms were the predominant cause of the abscesses. The most dangerous intracranial complication was subdural abscess, which occurred in seven patients in this series. Three of them died. Four cases of frontal and parietal lobe abscesses were treated with systemic antibiotics only. This approach has not been well emphasized in our literature. Steroid therapy should not be used for the treatment of sinus and orbital infections. It can result in dreadful complications. The overall mortality rate in this series was 21% (4 of 19), despite aggressive treatment and close cooperation between the neurosurgeon, otolaryngologist, and other specialists. Early diagnosis and adequate treatment are paramount.
This paper describes the events that transpired in the establishment of the Caribbean Primate Research Center (CPRC) and the role played by a number of individuals with interest in promoting primate research in Puerto Rico.
Six patients with parapharyngeal space tumors presenting intraorally over the past 16 years were managed by transoral excision. All had benign tumors of salivary gland origin (1 monomorphic and 5 pleomorphic adenomas) and 3 of 6 patients were asymptomatic. There were no surgical complications and blood loss was minor in all cases. One patient, who had refused treatment for more than 40 years, presented with dyspnea and dysphagia, and required a tracheotomy for safe induction of anesthesia. Only one patient was hospitalized for more than 3 days and only one tumor recurred--as a malignant pleomorphic adenoma 3 years later.
Laryngeal obstruction due to fixation of the vocal cords by scar tissue in the posterior commissure is a serious complication of endotracheal intubation. Until recently, operative procedures, including unilateral arytenoidectomy, were recommended for the relief of such obstruction. Because arytenoidectomy adversely affects voice quality, alternative procedures designed to open the airway by restoring vocal cord mobility have been attempted with some success. We report our experience with six consecutive patients, five of whom had previously required tracheotomy for relief of airway obstruction from posterior glottic stenosis. In all patients, the operative procedure included a midline thyrotomy, excision of the posterior commissure scar tissue, and stenting. Vocal cord motion returned to normal or near normal in all six patients, and all have been decannulated. Subjective evaluation of voice quality was the same or improved postoperatively. Our experience suggests that restoration of an adequate airway in patients with posterior glottic stenosis can be achieved without sacrificing an arytenoid cartilage and voice quality.
The charts of 52 adult patients who underwent tracheotomy (49 after intubation) were reviewed to identify early complications of both endotracheal intubation and tracheotomy. The complication rate of endotracheal intubation was 57%, and of tracheotomy, 14%. None of the complications of tracheotomy was serious. Sixty critical-care nurses were surveyed about their attitudes regarding prolonged endotracheal intubation and tracheotomy. A large majority preferred tracheotomy for patients who require airway support, for several reasons. First, they felt that tracheotomy patients were more comfortable and, therefore, required less sedation and restraint. Second, the patients could communicate more effectively. Third, airway care was simplified. Ninety-two percent of nurses stated that they would prefer a tracheotomy for themselves or a loved one if more than 10 days of ventilatory support were required. We conclude that tracheotomy can be performed safely in this group of patients, and that it offers significant practical and psychological benefits compared to prolonged endotracheal intubation.
An epizootic of genital lesions was observed on baboons (four Papio sub-species) housed in two different outdoor breeding corrals. Serological analysis revealed strong prevalence of antibodies to Simian Agent 8 (SA8). This herpesvirus was subsequently recovered from skin lesions and identified by restriction endonuclease digestion of infected cell DNA. Observations of lesion type, frequency and location were suggestive of venereal transmission. The remarkable similarity between infection resulting from SA8 in baboons and herpes simplex virus in man suggests that the baboon is an excellent model in which to study genital herpes virus transmission and infection.
Patients presenting with orbital inflammation must be diagnosed promptly and treated aggressively. Appropriate therapy is based on the specific diagnosis and is highly effective and rewarding.
A method is described by which systematic decisions about future membership in a breeding colony of baboons are made on the basis of rarity of known genetic marker phenotypes, and reproductive performance.
Bossae formation is a common late complication seen following modification of the nasal tip during rhinoplasty. Prevention is our primary goal, and the incidence of this iatrogenic problem will decrease as the surgeon's understanding of the dynamics of healing in the altered nasal tip increases. We herein review the pertinent nasal anatomy, predisposing patient characteristics, and causative surgical maneuvers, concluding with our recommendations for prevention and treatment.
Most experienced head and neck surgeons recommend aggressive treatment--including radical surgery--for patients with resectable Stage IV cancers. Yet, given the poor overall cure rate of 15% and the deformity and disability often associated with treatment, one of the most frequently asked questions at our conference on tumors was: Are we really helping these patients? We found little data in the relevant literature to answer this or other questions. Are there subgroups with a better outlook? What is the evidence for palliation in the 85% of patients who fail treatment and how is it best achieved? How do patients and their families view their treatment in retrospect? To find the answers, we studied the records of 76 consecutive patients (previously untreated) who presented with Stage IV carcinoma of the upper aerodigestive tract in 1981-82. We also interviewed surviving patients or family members and friends by phone. Overall mean survival was 15 months, with a 2-year disease-free survival rate of 16%. More to the point, resectable patients treated with curative intent had a mean survival of 19.4 months, and 12 of 42 patients (29%) were disease-free at 2 years. Patients with laryngeal cancer had the best survival results, and patients with sinus cancers had the worst (25.2 vs. 10.5 months). Those with N2A staging lived longer than other groups (24.1 vs. 12.1 months). T4 lesions portend a particularly poor prognosis; mean survival was just 7.5 months and only 1 of 28 patients (3.6%) was alive and disease-free at 2 years. Twenty-five percent of patients returned to normal function, but 75% had significant problems eating or speaking.(ABSTRACT TRUNCATED AT 250 WORDS)
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Certain patterns of "lymphoma masquerade" are examined, where the diagnosis is very difficult to establish. The presence of prolonged symptoms prior to the acute event or indolent slow healing wounds should alert clinicians to the possibility that lymphoma may be involved. Localizing tumors in order to make a tissue diagnosis is one potential problem encountered even with computerized tomography, but magnetic resonance imaging has been helpful in demonstrating the presence of tumor mass. Included in this report is an unusual series of non-Hodgkin's lymphoma cases in which there was not an obvious tumor. Three patients presented with symptoms and findings of deep neck abscess, two of which were associated with an esophageal perforation or tracheoesophageal fistula. The other cases involved chronic sinusitis and an apparent viral polyneuropathy affecting multiple cranial nerves. Treatment of these non-Hodgkin's lymphomas and techniques for establishing the pathological diagnosis are discussed.