Matrix-driven translocation of cells and nonliving particles.

Cells of metazoan organisms produce and react to complex macromolecular microenvironments known as extracellular matrices. Assembly in vitro of native, compositionally nonuniform collagen-fibronectin matrices caused translocation of certain types of cells or polystyrene-latex beads from regions lacking fibronectin into regions containing it. The translocation process was not due to diffusion, convection, or electrostatic distribution effects, but may depend on nonequilibrium phenomena at the interface of contiguous collagen matrices formed in the presence and absence of fibronectin or particles.

Degloving approach for total excision of inverted papilloma.

Inverted papilloma, because of its insidious and aggressive clinical course, must be completely excised. Previously, the customary procedure advocated for this goal was a lateral rhinotomy. The degloving approach, which consists of lifting the soft tissues from the mid portion of the face, thereby furnishing unlimited exposure to the pyriform fossae and the lateral nasal walls, offers an excellent alternative to the lateral rhinotomy technique.

Local excision and radiotherapy for cancer of the oral tongue. A preliminary report.

A group of 18 patients with squamous cell carcinoma of the mid one-third of the tongue was treated by local resection and planned postoperative radiotherapy between 1976 and 1980. Tumors 0.5 cm or greater in thickness were included; no patients had cervical adenopathy.

Myofacial pain dysfunction syndrome: a clinical study of asymptomatic subjects.

The diagnosis of myofacial pain dysfunction (MPD), commonly called temporomandibular joint syndrome, has traditionally been made on the presence of a group of clinical symptoms that produce pain and limitation of movement. The cause of this common illness has been the subject of controversy for over half a century. There has been a lack of agreement on diagnosis, a cause, and treatment.

Intralaryngeal release for tracheal anastomosis.

An operation for obtaining additional length in order to achieve end-to-end anastomosis of the trachea without significant suture-line tension is described. The intralaryngeal procedure lengthens the larynx approximately 1 to 2 cm without restricting its function. It is an expedient, effective technique when used primarily, or adjunctively, with a suprahyoid or mediastinal release.

Treatment results of combined high-dose preoperative radiotherapy and surgery for oropharyngeal cancer.

Fifty eight patients receiving planned high-dose preoperative radiotherapy followed by en bloc oro-mandibular-cervical resection for oropharyngeal cancer were reviewed. These patients received continued close observation and care from both the Otolaryngology and Radiotherapy services. In light of the ongoing controversy of preoperative vs.

Radiotherapy for carcinoma of the nasal cavity.

Twenty-five patients with primary epithelial carcinoma of the nasal cavity without nodal or distant metastases were treated by irradiation between 1967 and 1978. Small field, beam-directed techniques delivered 6,000 to 7,000 rads with conventional fractionation. Control of the primary tumor was achieved in 21 (84%) patients after irradiation.

Bronchiectasis in pediatric patients resulting from aspirated grass inflorescences.

A grass inflorescence (flowering head) aspirated by a child is difficult to diagnose, and frequently cannot be retrieved by bronchoscopy. Of four pediatric patients with aspirated grass inflorescences, two had severe hemoptysis and the other two were septic at the time of diagnosis. Their chronic debilitation and bronchiectasis necessitated an eventual pulmonary resection, with full recovery in all four patients.

Prophylactic neck irradiation.

Treatment of subclinical cervical metastases from advanced squamous carcinomas of the nasopharynx, oropharynx, oral cavity, hypopharynx, and larynx remains contentious. Watchful waiting, elective neck surgery, and, more recently neck irradiation all have their advocates. The possibility of "sterilization" of the neck showing no clinical signs of metastasis has been especially appealing in concept.

Fibrous dysplasia of the ethmoid sinus.

Fibrous dysplasia of bones comprising the paranasal sinuses is well recognized. Depending on the anatomic areas of the skull involved by this neoplasm, a combined approach for surgical removal may be necessitated. A case of a patient with fibrous dysplasia of the ethmoid sinus, possibly the first reported case of such change in the ethmoid bone itself, is presented.

Unusual parapharyngeal lesions.

Six cases of unusual parapharyngeal lesions are presented in detail along with discussions of the anatomy, pathology, clinical aspects, and treatment methods of lesions in the parapharyngeal space. Newer techniques of CT scanning and selective embolization are discussed as they apply to management of such lesions. A plasmalymphocytic tumor with amyloidosis is described.

Composite resection without mandibular reconstruction.

While composite resection remains the fundamental surgical approach to carcinoma of the posterior oral cavity, removal or reconstruction of the adjacent segment of mandible remains contentious. Various grafts have been used with less than satisfactory and unpredictable results. Bone has been brought in, borrowed, reshaped, and implanted into the area of mandibular deficit; mandibular osteotomy has been attempted with primary closure as well.

Composite resection in the elderly: a well-tolerated procedure.

The advisability of surgery in the elderly must be weighed against continued nonoperative care. The gloomy prospects of the patient with uncontrolled carcinoma of the head and neck led to the development and wide application of the composite resection for control of carcinoma of the oral cavity. The risks involved in this major undertaking in the elderly have not been previously reported.

Use of computerized axial tomography of the head and neck region.

The use of the computerized axial tomography has been well received in the field of otolaryngology. Five cases are presented illustrating the capability of the total body scanner (Delta scanner) to contribute to radiologic diagnosis below the level of the base of the skull. The advantages of non-invasibility and three dimensionality are compared to the disadvantages of added cost, added radiation exposure, comparatively long exposure time and relatively poor detail.

Tissue-cultured head and neck tumors: their use in in vitro assays of immune response.

Samples of 35 tumors from the head and neck region (25 squamous cell, 2 basal cell, 5 parotid, 3 melanoma, and 1 lymphosarcoma) were cultured after dispersement with either trypsin or collagenase treatment. Growth was established in 14 (40%). Cultured tumor cells were then used as target cells in in vitro assays of patients' cellular and humoral immunity to their own or similar tumors.

Apnea and airway obstruction during feeding and sleep.

Recent awareness of the magnitude of sudden unexplained deaths in apparently healthy infants has lead to an increased interest in those circumstances that are associated with or can elicit prolonged and serious apneic episodes. In the present studies, attention was directed toward the study of physiologic activity during sleep and feeding. Apneic episodes of varying durations occur during sleep which, in some instances, can be of sufficient length to warrant resuscitative intervention.

Osteogenesis imperfecta of the stapes: an histological study.

Two cases of Van der Hoeve's Syndrome are presented with histological findings consistent with the diagnosis of osteogenesis imperfecta. These findings support the view that otosclerosis can be clearly differentiated histologically from osteogenesis imperfecta. Pre-operative impedance studies are recommended on each patient with osteogenesis imperfecta as a useful diagnostic adjunct to determine whether the conductive component in the hearing loss is secondary to stapedial crural deformity and/or footplate fixation.

Primary solitary lymphoma of the trachea.

A case history is reported of an 81-year-old woman with progressively increasing airway obstruction and progressive stenosis of the intrathoracic trachea. Repeated endoscopic biopsies failed to establish a diagnosis. At thoracotomy, an isolated tumor mass was found originating in the trachea without grossly apparent mediastinal nodes.