Bacillary angiomatosis: a new entity in acquired immunodeficiency syndrome.

Since the recognition of the acquired immunodeficiency syndrome (AIDS) in 1981, previously rare infections and neoplasms have become increasingly common. Bacillary angiomatosis, undescribed in the medical literature prior to 1983, is now second in frequency only to Kaposi's sarcoma with respect to the cutaneous manifestations associated with human immunodeficiency virus (HIV) infection. Caused by Rochalimaea henselae, bacillary angiomatosis is easily treated, when diagnosed early, with erythromycin. We present two cases of bacillary angiomatosis that presented to Toronto General Hospital and review this new and clinically interesting entity. The incidence of bacillary angiomatosis will undoubtedly increase as the HIV epidemic accelerates. Since bacillary angiomatosis commonly affects the head and neck region, it is important for the otolaryngologist to become increasingly proficient in its diagnosis and treatment. The current AIDS crisis demands that the otolaryngologist become aware not only of bacillary angiomatosis, but also of the other cutaneous head and neck manifestations of HIV infection.

Otogenic intracranial complications.

The ear has been recognized as a source of intracranial infection at least since the time of Hippocrates. Not much progress was achieved in the diagnosis and treatment of intracranial sepsis until the latter part of the 19th century when surgeons such as McEwan began a direct surgical attack on brain abscesses. While the advent of the antibiotics in the 1940's and 1950's made a significant reduction in the mortality of meningitis, the surgical treatment of brain abscess has not altered much since then. Newer diagnostic methods such as the CTT scan should help to reduce mortality rates which even recently have varied from 7-40 per cent for brain abscesses.

Surgical treatment of extensive tumors of the lateral face and auricular area by radical soft tissue and subtotal temporal bone excision with deltopectoral flap coverage.

A method of excision of extensive tumor in the parotid and peri-auricular area with a partial temporal bone excision in discontinuity, has been described. In selected tumors local control has been as satisfactory as following more radical en bloc soft tissue and temporal bone excisions and without significant morbidity or operative deaths. The results in 15 patients treated by this method are described. The authors believe that the small number of patients in this and other reported series does not accurately reflect the frequency of tumors which could be treated successfully by this method, but does reflect a reluctance to advise the better known radical en bloc temporal bone excision with its associated morbidity and operative mortality.

Multiple tumors of the parotid gland.

Multiple tumors in a single major salivary gland are rare. Recently a patient with an acinic cell carcinoma and a Warthin's tumor in the same parotid gland was surgically treated at the Toronto General Hospital. A review of the world literature failed to reveal any report of this combination of tumors in the same gland.

Sinogenic and otogenic brain abscesses--a review of 63 cases occurring at Toronto General Hospital, 1956-75.

Sixty-three cases of brain abscess resulting from ear and paranasal sinus infections were reviewed. These patients were seen at the Toronto General Hospital from 1956-1965 and from 1969-1975. Comparisons are made relating to site, age and sex incidence, mortality rates, bacteriology, and rate of associated meningitis. Modern diagnostic methods are reviewed with particular emphasis on the use of the C.T. scanner.