Endoscopic examination of corrosive injuries of the upper gastrointestinal tract.

The authors present the case histories of five patients who have sustained corrosive injuries of the upper gastrointestinal tract. Flexible endoscopic examination was successfully carried out in each patient to assess the extent of the injury and anticipate further therapeutic needs. Three patients sustained major gastric lesions, i.e., strictures or bleeding following the ingestion of alkali, acids, or phenol, and one instance of esophageal stricture was recognized. The endoscopic observation of antral gangrene was inexorably followed by antral stricture requiring surgical management. One fatality followed rigid esophagoscopic examination which resulted in esophageal perforation.

Problems of diagnosis in the evaluation of mediastinal sarcoidosis.

The diagnosis of sarcoidosis can be established when the case meets the criteria of clinical course, radiologic findings, and supportive histology. When there is variation from the established criteria and the clinical course of age, systemic evidence of disease or the radiologic findings of unilateral or solitary adenopathy are encountered, then ongoing evaluation is necessary to identify a possible second disease existence. Cases have been presented which indicate some problem requiring further investigative studies before acceptance of the diagnosis of sarcoidosis.

Fractures of the edentulous maxilla and mandible.

An evaluation and treatment of fracture of the edentulous maxilla and/or mandible is presented. The Le-Fort classification of maxillary fractures is the foundation for the program of care. Immobilization techniques are based upon the support of a fracture by suspension from the adjacent stable segments to the modified prosthesis. The mandibular fractures are repaired by interosseous wire fixation in the body and symphysis region, the other fracture sites are supported by circumferential wiring to the prosthesis for immobilization. General principles of time of repair, diet, types of healing factors are reviewed.

Effect of sound deprivation on central hearing.

The authors have investigated the thesis that intermittent hearing impairment due to middle ear disease in the early years of life results in a central auditory disturbance which may persist in adulthood. The concept that, during the speech development years, auditory disturbances interfere with the normal maturation of central auditory processing appear to be clearly established. Thirty-five children, free of active ear disease and normally hearing by standard peripheral audiometry, are the basis for the study. The monotic tests employing temporal and frequency distortion and the dichotic challenges of competing stimuli and central integration provide the test data. Approximately 75% of the study group fail at least 1 segment of the battery, beyond 2 standard deviations from the normal data. A decreasing percentage of the study group exceed the normative values in 2 or more of the test components. In view of these data on aggressive program of auditory conservation is suggested during the early years of life.

Central auditory testing and dyslexia.

A group of dyslexic pupils with normal end organ function was studied by a central auditory battery to determine whether a hearing disability existed. The clinical features of dyslexia are presented with emphasis on the psychological developmental and functional disorders associated with this reading problem. The central battery of Willeford was selected as the test medium and the results of the 77 dyslexic students were compared to the normative data. The model proposed by Sparks, et al., is accepted as the mechanism for dichotic audition. Reference is made to the organic basis of reading disorders from lesion in the calcarine area to the angular gyrus. The competing sentence test, binaural fusion, rapidly alternating speech perception, and filtered speech are described in detail and are organic foundation for the study. The authors indentified a high rate of failure in this investigation. Over 50% of the dyslexic students failed two of the four tests, and each of the 77 failed at least one component. The most sensitive tests were binaural fusion and filtered speech with less variation from the norm in the remaining two components. The effect of maturation in central audition was measured in each of the four tests. The data suggest: 1. the scores are lower in the early ages in each test; 2. that rapidly alternating speech and competing sentences approach the normal range albeit somewhat delayed; and 3. that binaural fusion and filtered speech improve in score somewhat but rather moderately and never approach the normal range. Based upon the central auditory data and in conjunction with the anatomical pathways of vision, the authors suggest the site of lesion to be in the temporo-parietal cortex and the association fibers.

Central presbycusis.

The phenomenon of central presbycusis has been investigated employing a central auditory battery in elderly individuals with essentially normal hearing. The studies indicate a progressive loss in central auditory competence measured by simultaneous binaural challenges and frequency and temporal distortion tests. The rate of failure is related to age, on the whole, but there is increasing variability from the normals with seniority. The hearing disability in noise or speech competitive environments is explained by these data. Auditory disabilities related to poor articulation and rapid speech presentation are identified by other tests in the battery. Central presbycusis, in addition to the peripheral form, does exist and further compounds the hearing disorder in many elderly.

Syndromal vertigo identified by magnetic resonance imaging and angiography.

The advent of magnetic resonance imaging and angiography has clarified the location and vascular basis for vertigo of a syndromal type. The composite presentation of a vestibular symptom with evidence of cranial nerve or cerebellar dysfunction suggests a lesion within the pons, medulla, or cerebellum. The location may be exactly defined by noninvasive techniques and appropriate therapy can be initiated. Clinical examples are presented; the syndromes of vertebrobasilar artery perfusion disorder are described, and appropriate images are illustrated for confirmation.

Evaluation of the vestibular system by magnetic resonance angiography.

This report describes the normal arterial patterns of the vestibulocerebellar regions visualized by magnetic resonance angiography. Variations in the vertebrobasilar arterial system are described, limitations in imaging are discussed, and collateral connections within the cerebellar vessels and the circle of Willis are reviewed. Clinical correlations are defined between the vestibular nuclei, the associated intraaxial tracts, and with specific posterior cerebral and brain stem arteries.

Effects of irradiation of cervical lymph nodes.

The effects of irradiation upon the functional integrity of lymph nodes were studied in the isolated cervical region of the dog. After 6000 rads were applied in one dose plan, the measure of lymph flow was determined by the migration of radiogold from the larynx to the associated primary lymphatic terminals at intervals of 2, 4, and 12 weeks, and six months post-irradiation. Interference with lymph flow was identified by radionuclide stasis in the injection depot; alteration in the direction of flow was identified by relative concentration of the tracer item in the associated nodal terminals. The lymph flow was minimally distorted by irradiation in the test period unless secondary damage to the associated lymphatic channels intervened. The relative migration was consistent with the normal data in 52%, depressed in 13% and increased in 35% of the cases studied. Major obstruction and rerouting of lymph flow contralaterally was evident in 19% of the subjects due to fibrosis secondary to local infection.

Mediastinoscopy: the predictive survival value in staging carcinoma of the lung.

One hundred and thirty-seven cases of Stage III lung cancer established by mediastinoscopy have been followed to determine their survival. The tissue was classified according to World Health Organization schema and the degree of dedifferentiation graded from well to poorly differentiated. Two percent of the presented cases are well-differentiated tumors; the remaining 98% are moderately well-differentiated (11%), or poorly differentiated or small cell tumors (87%). The degree of anaplasia suggests an increasingly aggressive metastatic behavior pattern. The average life span is approximately 5 1/2 months in all groups and subgroups which were studied. Recommendations are presented for the utilization of mediastinoscopy in Stage I and II cases. Further considerations are suggested for priority of diagnostic procedures in establishing the diagnosis of lung cancer.

Basilar artery and vertigo.

Our goal was to identify by magnetic resonance angiography the specific vascular abnormalities of the basilar artery that can be related to hypoperfusion disorders and produce symptoms of vertebrobasilar insufficiency. A classification of regional vascular perfusion disorders based on developmental malformations and intrinsic and extrinsic angiopathies was formulated from an analysis of individuals with these disorders. Specific angiographic abnormalities such as tortuosity, stenosis, thrombosis, and dolichoectasia were identified in subjects with vestibulocerebellar dysfunction. Charts and radiographic images were examined with respect to the history, physical evidence, and vascular configuration, and the data were integrated for comprehensive analysis. We found that abnormalities identified by magnetic resonance angiography could be correlated with symptoms due to vascular insufficiency. Cases are presented that document the developmental and acquired arterial disorders that may be considered the etiologic factors for regional perfusion deficits.

Vertigo: analysis by magnetic resonance imaging and angiography.

The relationship of vascular disease of the vertebrobasilar artery system to isolated vertigo was examined by magnetic resonance imaging and angiography. Eighty-nine individuals complaining of vertigo were evaluated by standard otoneurologic investigations, and the data were correlated with the vascular patterns of the cervical region and posterior fossa. The age distribution extended from the fourth decade to the ninth decade; the peak occurrence was observed in the eighth. Approximately 85% of the group experienced numerous episodes of vestibular dysfunction from months to years before examination; the remaining segment was examined following the first episode due to severity or persistence of symptoms. The criteria for vascular abnormality proposed by the authors are based upon comparison with previous normal findings. Approximately 52% of the cohort demonstrated abnormal configurations or evidence of diminished flow within the vertebrobasilar artery system. Of this segment, a vertebral artery was most frequently abnormal, in 76%; the basilar artery was judged pathological in 32%, and combined disease of several arteries was evident in 20%.

Function of a hearing aid under stressful conditions.

The auditory function of individuals with normal hearing was compared with that of hearing-aided subjects of similar age to determine whether amplification remediates hearing impairment under stressful auditory situations. The specific tests of listening in a competitive noise environment and identifying moderately compressed speech were introduced to adequately aided individuals. The data indicate that noise had an impact on auditory function to a much greater degree in aided individuals than in matched counterparts with normal hearing. The data derived from acceleration of simple sentences delivered to the aided group suggested that contrary to basic tonal sensitivity, the capacity to understand the stimulus was greatly compromised. The authors discuss cochlear damage and central auditory impairment as they relate to the limitations of amplification for sensorineural hearing loss.

Massive orofacial abscesses of dental origin.

Massive cervicofacial abscesses of dental origin are relatively rare, and may be associated with serious and grave morbidity. In extreme cases, an occasional fatality may result from regional complications. Three cases are presented that describe the clinical and radiographic evaluation and the surgical approaches for abscess drainage. Specific attention is directed toward 1) the management of imminent airway obstruction, 2) the application of computed tomographic technology for localization and surgical planning, and 3) current antibiotic therapy.

Dysphagia due to cervical spine surgery.

Surgery upon the cervical vertebrae may produce prolonged dysphagia due to regional damage, hemorrhage, infection, and denervation. Cases illustrating these problems are presented with attention to the progression of the clinical course and the diagnostic modalities of radiology and endoscopy. Methods of prevention are emphasized and the therapeutic plan is outlined.

Internal anatomy of the larynx and the spread of cancer.

This project investigated the potential spread of cancer within the larynx by an analysis of the permeability and resistance of the subepithelial spaces. Permeation and diffusion of dye injections in the loose connective tissues below the epithelium was analyzed by histologic preparations in the sagittal plane. The margins of the infusion were identified grossly and microscopically, and the influence of the fibrous, elastic, and muscular components was analyzed with reference to the dispersion of the dyes. A close correlation between laboratory data from normal postmortem larynges and clinical problems of laryngeal cancer was observed in this study.

Radiographic analysis of deep cervical abscesses.

Correlation of the radiographic examination and the clinical evaluation of deep cervical abscesses contributes to the surgical program for exposure and drainage. The deep cervical spaces are analyzed with reference to local anatomy, sources of infection, potential for lateral and vertical extension, and identification of regional expansion by standard and computed tomography. Guidelines and recommendations are proposed for clinical application and supported by illustrative cases.

Early sound deprivation and long-term hearing.

The long-term effects of hearing loss in early life were analyzed by tests of central auditory function. A majority of individuals failed the Compressed Speech identification with statistically significant results. There was an impact on a minority of individuals evaluated by Dichotic Sentences; little impairment was noted through Speech Reception in Noise. Delayed maturation of the central auditory complex may improve these findings, although during the period of investigation a negative impact was measured. Other issues of diagnosis, remediation, and the consequences of short- and long-term deafness are discussed.

Cortical, subcortical, and brainstem dysfunction: a correlation in dyslexic children.

A group of dyslexic students was examined by a central auditory test (CAT) battery including competing sentences, binaural fusion, filtered speech, and compressed speech. Auditory evoked brainstem responses (BSER) were measured in conjunction with the CAT data. The auditory tests indicate a high degree of failure in those areas requiring sophisticated integration, coordination, and identification of the modified speech stimuli. The BSER did not identify a significant abnormality. The cortical and subcortical areas of integration are proposed as the multicentric sites of impairment in the hearing function found in dyslexic students.

Learning disabilities and central auditory dysfunction.

Hearing loss, whether peripheral or central, compounds the communication and educational problems of the learning disabled student. A central auditory processing disorder uniquely interferes with both the input and integration of verbal information, further resulting in a potentially permanent cognitive dysfunction during the developmental period of acquisition of language. Illustrative cases are presented that indicate the panorama of cognitive dysfunction associated with the learning disabled status. Methods of evaluation and identification and diagnostic criteria are correlated with auditory, visual, and academic performance. Comments regarding clinical awareness, prompt recognition, and ensuing individualized remediation are submitted.