Defective enamel ultrastructure in diabetic rodents.

We investigated six different types of diabetic rodents. Four expressed a genetic obesity resulting in diabetes. One developed diabetes induced by a diet-dependent obesity, and one with genetic diabetes received anti-diabetic medication. The tooth samples were examined under a scanning electron microscope and with an energy dispersive microanalysis (EDX). The electron micrographs showed severe, varying degrees of damage within the six different diabetic animal types, such as irregular crystallite deposition and prism perforations in genetically obese animals compared to less-disordered prism structures in diet-dependent obesity. Anti-diabetic medication resulted in normal enamel ultrastructure. The EDX analysis revealed a reduction in the amount of calcium and phosphorus in all regions affected by diabetes. Based on these animal studies, we suggest that both juvenile diabetes type I (in infants) and adult diabetes type II (in pregnant mothers, affecting the developing foetus) may affect the normal development of teeth in humans.

Endoscopic repair of cerebrospinal fluid rhinorrhea.

Endoscopic repair of cerebrospinal fluid rhinorrhea is a promising alternative to traditional repair techniques. This article reports our experience with 21 cases (10 spontaneous, 8 iatrogenic, and 3 traumatic). Various diagnostic radiographic modalities were used, including computer-aided techniques. Most repairs were accomplished with a free fascial graft positioned in the epidural space. Postoperative lumbar drainage was used in 15 cases. Initial repair was successful in 18 cases (85.7%). In all 3 failures, the surgeon had difficulty with proper graft placement. Additionally, 2 of these cases were confounded by early inadvertent removal of the lumbar drain. All patients in whom the procedure failed underwent a second successful endoscopic repair. There were no major complications. In our experience endoscopic repair of cerebrospinal fluid rhinorrhea is a safe and effective approach that can be improved with computer-aided localization devices. Proper graft placement is critical, and lumbar drainage is an important adjunct in selected cases.

Delayed pharyngoesophageal perforation: a complication of anterior spine surgery.

Stabilization of the cervical spine is often accomplished via an anterior cervical approach. Bone grafts and/or plates and screws are used to achieve stabilization. Injuries to the pharynx and esophagus are known complications in anterior exposure of the cervical spine. These injuries are manifest in the early postoperative period. Reports of late perforations are very rare. We present four cases of delayed injury to the pharynx and esophagus that resulted in abscess or fistula. We postulate that graft displacement with resulting erosion was responsible for these serious complications. Postoperative odynophagia in patients who undergo anterior cervical fusion warrants evaluation of the bone graft location. Early surgical intervention and repair may decrease prolonged morbidity in these patients.

Diagnosis and management of cleft larynx. Literature review and case report.

Laryngeal cleft is a rare congenital laryngeal anomaly that has been recognized more frequently in recent years. It can be a serious problem, consisting of separation of the arytenoids with a fissure resulting from a defect in the fusion of the posterior cricoid cartilage lamina. Dysphagia with aspiration of food is commonly seen with resultant bouts of pneumonia. Surgical repair has been successful in a handful of cases. This communication will review our institution's recent handling of a case successfully treated. The epidemiology, embryology, classification, diagnosis, and suggested treatment regimen for laryngeal cleft will also be outlined.

Approach for oxygenation of the newborn with airway obstruction due to a cervical mass.

Large congenital cervical neck masses present major difficulties in management of the neonatal airway at delivery and in the perinatal period. With ultrasound, these lesions can be predicted prenatally. An airway treatment plan can then be formulated and modified in relation to the airway presentation at birth. We describe a case of a massive cervical-mediastinal teratoma and our management plan. Preparation involved a multidisciplinary approach including endoscopy to secure the airway while the neonate remained on fetal circulation and an extracorporeal membrane oxygenation system was available. Once the infant's condition was stable, a cervical approach with resection of the massive teratoma with mediastinal dissection without sternotomy was successful. A differential diagnosis of cervical neck masses and review of cervical teratomas is presented.

Laryngeal granulomatous polyp after short-term intubation of a child.

It is well known that prolonged endotracheal intubation may result in formation of laryngeal granulomata. It is rare to find such lesions following short-term intubation. Furthermore, the virtual absence of such granulomata in children has been attributed to certain characteristics of the pediatric larynx. We report a 7-year-old child who developed a laryngeal granulomatous polyp following endotracheal intubation for less than 12 hours. A discussion of the incidence, pathogenesis, and treatment of this and other postintubation laryngeal lesions follows.

Decruitment and abnormal auditory adaptation.

1. Factual findings related to decruitment have been presented. 2. Decruitment is considered to be a manifestation of eighth nerve involvement indicating abnormal adaptation. 3. Loudness match as a quick screening test may be applied in cases of suspected abnormal auditory adaptation.

Computed tomography of salivary glands in Sjögren's syndrome.

Three cases of Sjögren's syndrome, one with uncomplicated disease, and the other two complicated by pseudolymphoma and malignant lymphoma, respectively, are presented. Computed tomography can provide information useful in the diagnosis, detection of complications, and, therefore, management of Sjögren's syndrome.

Treatment of neonatal necrotizing tracheobronchitis with extracorporeal membrane oxygenation and bronchoscopy.

Necrotizing tracheobronchitis has recently been described as a complication of mechanical ventilation of newborns with respiratory failure. Despite the use of bronchoscopy, 45% of the reported patients to date have died. In this study, we report the use of extracorporeal membrane oxygenation (ECMO) to stabilize two patients with necrotizing tracheobronchitis. While supported by bypass, both patients underwent prolonged bronchoscopies with removal of extensive amounts of tracheal debris. ECMO provided efficient oxygenation in the face of near total airway occlusion, and permitted far more extensive bronchoscopic debridement and lavage than would have been possible if the lungs were required for oxygenation. In addition, ECMO provided a period of lung "rest" during which ventilator settings were reduced, thus minimizing further barotrauma and allowing for lung and airway healing. Both patients recovered without significant respiratory sequelae. ECMO and bronchoscopy are effective forms of therapy for patients with life-threatening necrotizing tracheobronchitis when conventional modalities of treatment have failed.

Non-epidermoid carcinoma of the larynx: the Thomas Jefferson University experience.

Nonepidermoid cancers of the larynx appear with consistency in large series of laryngeal tumors. We reviewed 1135 laryngeal cancers seen over a 24-year period at Thomas Jefferson University Hospital and found a 1.7% incidence. This is similar to several other large series. These patients are presented in terms of their sex, age, race, clinical presentations, therapies, and outcomes, and a review of these unusual tumors is given. The recognition of such lesions is important because many require different therapies and have different prognoses than their squamous cell counterparts. The relatively infrequent occurrence of these tumors makes the availability of controlled clinical studies extremely difficult.

Measures of middle ear admittance during experimentally induced changes in middle ear volume in the hamster.

The relation between middle ear admittance measured at the tympanic membrane and middle ear volume was studied in adult hamsters. A modified tympanometric procedure was used to measure complex admittance at eight test frequencies. Middle ear volume was varied by injecting small amounts of water into the bulla cavity. As bulla volume decreased, the value of admittance magnitude also decreased. The measured values of admittance magnitude could be accurately predicted by the equation for admittance magnitude until the bulla was about 70% filled. The results confirm that measures of middle ear admittance reflect the volume of the middle ear cavity as would be expected of a pure compliance. Where such measures are available in man, they might be used to predict the degree of fluid intrusion into the middle ear cavity.