Clinical presentation, processes and outcomes of care for patients with pneumococcal pneumonia.

Objective: To describe the presentation, resolution of symptoms, processes of care, and outcomes of pneumococcal pneumonia, and to compare features of the bacteremic and nonbacteremic forms of this illness.

Design: A prospective cohort study.

Setting: Five medical institutions in 3 geographic locations.

Vocal cord injection with autogenous fat: a long-term magnetic resonance imaging evaluation.

Since 1987, the senior author has injected autogenous fat into paralyzed or atrophic vocal cords as an alternative to alloplastic substances for vocal cord augmentation and medialization. To determine the fate of the injected autogenous fat, the injected vocal cords of 10 patients were evaluated by laryngeal magnetic resonance imaging (MRI) in the sagittal, coronal, and axial planes. Imaging studies were performed as early as 17 hours after surgery to as long as 31 months after fat injection.

Last-minute preoperative cardiology consultations: epidemiology and impact.

To identify clinical predictors of last-minute preoperative cardiology consultations and to evaluate the impact of these consultations on patient care, we performed a retrospective case-control study including all 166 patients who received unscheduled cardiology consultations at the preadmission testing center (PATC) of an urban teaching hospital. Control subjects were 166 patients matched by date and category of surgical procedure. Significant (p < 0.

Malignant oncocytoma of the lacrimal sac: ultrastructure and immunocytochemistry.

Malignant oncocytoma of the lacrimal sac is a rare tumor. A third example is presented here. In addition to oncocytes, tumor acini also harbored a few mucin cells and myoepithelial cells.

Modified neoglottis reconstruction following total laryngectomy: long-term follow-up and results.

In 1978 a surgical procedure was developed to create a neoglottis from the upper tracheal rings to facilitate speech rehabilitation in patients who had undergone total laryngectomy for carcinoma of the larynx. To date, 45 such procedures have been performed and results indicate rapid postoperative speech rehabilitation in nearly all patients, good long-term speech results, and low morbidity. This procedure has served as a very successful alternative to the more frequently used tracheoesophageal puncture (TEP) and prosthetic valve technique.

Practice guidelines and malpractice litigation: a two-way street.

Objective: To understand how practice guidelines are used in malpractice litigation.

Design: Review of the open and closed malpractice claims of two medical malpractice insurance companies, and a mailed survey of attorneys who litigate malpractice claims.

Setting: United States.

Factors influencing functional outcome in supraglottic laryngectomy.

Background: The relationship between preoperative pulmonary function tests (PFTs) and postoperative aspiration and deglutition complications in supraglottic laryngectomy (SL) has not been adequately analyzed. The effects of numerous other variables are either controversial or have not been studied.

Methods: A retrospective chart review was performed on 46 SL patients, analyzing preoperative PFTs and arterial blood gases, demographic factors, stage of disease, extended resections, cricopharyngeal myotomy, hyoid preservation, neck dissection, and postoperative radiotherapy with regards to aspiration and deglutition problems.

Sulcus vocalis in laryngeal cancer: a histopathologic study.

The incidental finding of sulcus vocalis in surgical specimens of patients with laryngeal cancer prompted this review. Sulcus deformities were histologically identified in 28 (48%) of 58 whole-mount coronal serial-sectioned laryngeal specimens procured from laryngeal cancer patients. The lesions were analyzed, described, and graded.

Dedifferentiated chondrosarcoma of the larynx with regional and distant metastases.

Chondrosarcoma of the larynx is an unusual tumor, with only approximately 200 cases having been reported. This tumor is relatively nonaggressive and tends to remain localized in the larynx. Two cases with aggressive clinical behavior manifested by regional or distant metastasis are presented.

Clinical underestimation of laryngeal cancer. Predictive indicators.

Objective: To evaluate the accuracy of clinical staging of advanced laryngeal cancer and to morphologically analyze the underestimated cases.

Design: We conducted a retrospective histopathologic study of larynges from patients who had had total laryngectomy and were seen over a 21-year period.

Setting: Academic tertiary referral medical center.

Laser cordectomy or radiotherapy: cure rates, communication, and cost.

Health care costs have risen dramatically in recent years. Cost-containment strategies have become necessary to ensure that adequate medical care is accessible to all who need it. These strategies include choosing the least costly of several treatment modalities with equal efficacy.

Vocal cord augmentation with autogenous fat.

Since 1987, the authors have used a new technique for the augmentation and medialization of the paralyzed vocal cord. Eleven patients with paralyzed vocal cords and one patient with a surgical defect of the vocal cord have been treated with intracordal injections of autogenous fat harvested by suction from the abdominal wall. Treatment efficacy was evaluated by both subjective and objective (videostroboscopic) analyses.

A modified neoglottis procedure: update and analysis.

In recent years, various techniques have been introduced for construction of an epithelium-lined shunt between the trachea and the esophagus or hypopharynx. We described a rigid neoglottis in a preliminary report of 12 cases in which the upper tracheal rings were used to construct the epithelium-lined tract. This study reports the cases of 22 additional patients and offers an in-depth analysis of additional demographics, complications, and long-term speech results that quantify the vocal characteristics of neoglottic speakers.

Primary irradiation, surgery or combined therapy in squamous cell carcinoma of the larynx. A comparison of treatment results from two centers.

We compared two groups of patients with squamous cell carcinoma of the larynx. Group 1 consisted of 483 patients treated from 1958 through 1978. Primary surgery was selected in 41% pre- or postoperative radiation therapy in 16% and primary radiation therapy in 43%.

Variables contributing to distress in male cardiac patients.

Fifty-five male subjects attending a cardiology clinic were examined using a structured interview keyed to a 12-item Hamilton Anxiety Scale (HAS). Sixty-five percent scored in the range of moderate to severe distress with highest mean scores on the following subscales: anxious mood, tension, insomnia, muscular complaints, and global behavioral distress. Two-way analysis of variance revealed the following factors to be significantly associated with higher total HAS scores: greater number of medical diagnoses (P = .

An objective assessment of voice production after radiation therapy for stage I squamous cell carcinoma of the glottis.

Radiation therapy has been the primary treatment for early glottic carcinoma, especially when restoration of normal voice is essential; yet objective evidence of the status of vocal function after treatment is lacking. The purpose of this study was to assess vocal characteristics of patients with glottic carcinoma after they had undergone radiation therapy. Twenty males, who had previously been treated with external beam irradiation for T1N0M0 squamous cell carcinoma with no subsequent evidence of recurrence, volunteered for this study.

Coronal sections of larynges from radiation-therapy failures: a clinical-pathologic study.

Serial coronal sections of 89 wide-field laryngectomies were examined. Twenty were specimens obtained from laryngectomies to treat patients for whom primary radiation therapy failed to cure early laryngeal cancer. These specimens were compared to 69 specimens from laryngectomies for T3 and T4 laryngeal cancers.

Spontaneous remission in diffuse large cell lymphoma.

A case of spontaneous remission in a Stage IIA diffuse large cell lymphoma is presented. Review of the literature suggests that whereas spontaneous regressions are a well-recognized phenomenon in indolent lymphomas, it is extremely rare in lymphomas of aggressive histologic subtype.

An epidemiologic study of oral cancer in a statewide network.

A case-control study was conducted to investigate the risks of male and female oral, oropharyngeal, and hypopharyngeal cancer associated with poor oral health, mouthwash use, occupation, histories of tobacco and alcohol use, and other factors. Data were collected from all newly diagnosed patients entered into the Wisconsin Head and Neck Cancer Network over an 18-month period (N = 623). The prevalence of painful or ill-fitting dentures was significantly higher among males and females with oral cavity cancer.

Significance of apparent intratympanic meningiomas.

Meningioma is the most common tumor of the central nervous system, but it has only been reported in 79 patients to involve the temporal bone. The 4 cases presented here show striking clinical similarity to a subgroup of 20 meningiomas reported to be entirely intratympanic; however, in each instance the extent, origin, and potential of the disease was not initially evident. Precise histopathologic diagnosis may be aided by electron microscopy.

Circadian changes in the response of the rabbits retina to flashes.

It was previously shown that in rabbits the electroretinogram (ERG) and the visually evoked potential show a circadian rhythm consisting of a stable phase during which the animals respond to flashes with day time potentials and another phase with night time potentials (NTPs) and that the occurrence of the sharp phase transitions is programmed by the time course of the preceding light-dark schedule. From the present investigation it follows that photic sensitivity to flashes is markedly higher during the NTP-phase than in the other phase, whereas dark adaptation runs the same time course in both phases. With respect to the ERG it appears that, over a wide range of flash intensities its b wave only is affected by phase of the rhythm.

The eleventh nerve in radical neck surgery.

The greatest morbidity associated with the radical neck dissection has been the "shoulder syndrome" due to the sacrifice of the spinal accessory nerve. Despite the fact that the XIth nerve can be spared by a careful dissection of the postcervical triangle, to do so remains a controversial issue. The 125 radical neck dissections performed at the University of Wisconsin Clinical Science Center from 1970 through 1975 were carefully evaluated to determine the incidence of recurrent tumor in the operated-on neck.