Congenital vascular anomalies of the aortic arch are unusual etiologies of dysphagia in the adult. Swallowing abnormalities associated with compression of the esophagus primarily occur at birth or in the immediate neonatal period. However, as the result of arteriosclerotic vascular disease or aneurysm formation, anomalies which were asymptomatic postnatally may produce dysphagia in the adult. A retrospective analysis of 59 cases with aortic arch anomalies presenting initially in adulthood revealed characteristic clinical signs and symptoms. An aberrant right subclavian artery with left aortic arch was the most frequently encountered abnormality. The embryologic development of each vascular anomaly is described and the value of selective arteriography with contrast esophagography is stressed. Patients with minimal swallowing impairment are treated with dietary management alone. Surgical division of the anomalous artery is indicated only when severe dysphagia is associated with progressive life-threatening anorexia and weight loss.

Adult↗

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Complications of intubation.

Endotracheal intubation with current inert low-pressure, high-volume cuffed tubes is a safe procedure associated with few complications in the vast majority of patients. However, complications related to mechanical difficulties and mucosal injury can occur even under ideal circumstances. Immediate complications are primarily associated with problems during intubation and extubation while early and late complications represent the short- and long-term effects of epithelial trauma.

Equipment Failure↗

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Aspergillus thyroiditis.

A case of fatal disseminated aspergillosis in a renal transplant patient is presented. The initial manifestation of the disease was consistent with thyroiditis. Autopsy findings are shown and support this unique presentation. The diagnosis of aspergillosis is difficult to make and may require pulmonary biopsy. Early diagnosis and treatment with amphotericin B are the keys to successful management of the disease.

Adult↗

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Pediatric infectious cervical lymphadenitis.

Infectious cervical lymphadenitis is a frequently encountered problem in the pediatric population. The recent experience with infectious cervical lymphadenitis at the Children's Hospital of Philadelphia was reviewed. The most common etiologic agent was Staphylococcus aureus. beta-Hemolytic streptococcus and mycobacterium were found in 15% and 6% of cases respectively. Other agents included pneumococcus, cat scratch, Toxoplasma gondii, actinomycosis, and mixed bacteroides and peptostreptococcus. Most patients responded to high-dose intravenous antistaphylococcal penicillin. Needle aspiration proved successful in identifying the casual agent in a high percentage of cases. Aspiration was also beneficial in draining small abscess cavities. Surgical drainage was rarely necessary.

Adolescent↗

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Factitious parotid tumor.

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Adult↗

PubMedDate not supplied

Acinic cell carcinoma of the oral cavity.

A rare case of acinic cell carcinoma of minor salivary gland origin within the oral cavity is reported in a 62-year-old woman. These tumors most commonly arise in the parotid gland and follow an insidious course requiring long-term follow-up. The gross and histologic features of the patient's tumor include pseudoencapsulation, mixed solid and acinar architecture, microcyst formation, and the presence of conspicuous diastase-fast and PAS-positive cytoplasmic granules, characteristic of lesions that have been called acinic cell carcinoma by a variety of authors. Surgical excision is the treatment of choice. However, following an incisional biopsy, the patient refused further surgical treatment and has remained clinically disease-free three years postoperatively.

Alveolar Process↗

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A method for determining cortical auditory thresholds in guinea pigs.

A method for measuring evoked cortical potentials to acoustic stimuli through the intact dura mater of the guinea pig without computer averaging studied. After exposure of the dura overlying the auditory cortex on the left side, thresholds to acoustic stimuli presented to the right ear were determined with a double tipped silver electrode by visual detection on an oscilloscope. The thresholds obtained are compared with other methods of determining audibility levels in the guinea pig. With relatively simple instrumentation, this method provides rapid and accurate determination of the audibility curve.

Acoustic Stimulation↗

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Cranal computed tomography: application to otolaryngology.

Cranial computed tomography (CT) is an effective radiologic method for the evaluation of extracranial and intracranial pathology. Representative cases of extracranial and intracranial pathology of otolaryngic interest are selected from 6,000 CT scans. Pathology of the nasal cavities, paranasal sinuses, orbits, and cerebellopontine angles is demonstrated.

Adolescent↗

PubMedDate not supplied

Hearing loss of a central type secondary to carbon monoxide poisoning.

The effect of carbon monoxide poisoning on the threshold sensitivity of the responses from the auditory cortex, inferior colliculus, and cochlea to acoustic stimuli in guinea pigs was studied. The toxicity of carbon monoxide is believed to be secondary to tissue hypoxia and is partially reversible. Loss of auditory threshold sensitivity in carbon monoxide poisoning is most prominent at the auditory cortex. The loss of sensitivity at the inferior colliculus is the next most severe. There is no loss of sensitivity at the cochlea. The relative vulnerability of the central auditory pathway to carbon monoxide poisoning as compared with the end organ is demonstrated.

Animals↗