ABSTRACT
Subcutaneous implantation of Gore-Tex for facial reconstruction allows physicians to recontour the soft tissues of the face and to augment areas that are deficient of subcutaneous tissue for genetic, aging, and traumatic reasons. This article discusses the use of Gore-Tex in multiple implant sites and presents novel ideas for both facial and cervical augmentation.
Subject(s)
Face/surgery , Facial Bones/surgery , Prostheses and Implants , Surgery, Plastic , Biocompatible Materials , HumansABSTRACT
Tracheoesophageal fistula without atresia (H-type) is a known but uncommon cause of respiratory distress in the newborn. We present a rare case of a high cervical tracheoesophageal fistula unassociated with a laryngeal cleft or esophageal atresia. The diagnosis, associated anomalies, and surgical repair of this previously undescribed entity are discussed.
Subject(s)
Tracheoesophageal Fistula/congenital , Abnormalities, Multiple , Female , Humans , Infant, Newborn , Tracheoesophageal Fistula/diagnosis , Tracheoesophageal Fistula/surgeryABSTRACT
The prevalence of Mycobacterium tuberculosis is increasing due in part to the rising incidence of immunocompromised hosts. Although Mycobacterium tuberculosis is a well-documented pathogen in otitis media and mastoiditis, its extremely low incidence often precludes consideration when treating these infections. This is especially true when concomitant pulmonary symptoms are absent. We describe two patients who initially presented after prolonged unsuccessful medical and surgical therapy for chronic mastoiditis. In both, the diagnosis of Mycobacterium tuberculosis mastoiditis was made after the onset of complete facial paralysis. On subsequent investigations, one had an asymptomatic pulmonary focus while the other was felt to have primary mastoid disease. Both patients had normal immunological profiles. This report underscores the importance of considering a tuberculous infection in all cases of otitis media and mastoiditis which do not initially respond to conventional antibacterial therapy. This holds true in both immunocompromised and immunocompetent hosts. Early diagnosis with prompt institution of antituberculous therapy is essential to avoid facial nerve paralysis and other grave complications.
Subject(s)
Mastoiditis/diagnosis , Otitis Media/complications , Tuberculosis, Osteoarticular/diagnosis , Adult , Facial Paralysis/etiology , Female , Humans , Male , Mastoiditis/complications , Mastoiditis/surgery , Middle Aged , Tomography, X-Ray Computed , Tuberculosis, Osteoarticular/complications , Tuberculosis, Osteoarticular/surgeryABSTRACT
The objective of this study was to determine the potential application of fine needle aspiration (FNA) and flow cytometry (FCM) for the diagnosis of non-Hodgkin's lymphoma (NHL). At our institution, we have used FNA coupled with FCM to accurately diagnose both reactive lymphoid processes and most lymphomas in a prospective series of more than 90 patients. A retrospective review of 266 patients with NHL who were treated at the London (Ont.) Regional Cancer Centre over a five-year period was performed. Two-thirds presented with palpable lymphadenopathy which would have been amenable to FNA. Based upon the results of our prospective study, FNA/FCM could have provided an accurate diagnosis of malignancy for these patients. Furthermore, the subclassification of the lymphomas would have been accurate in 75% of cases. For 25% of patients, including those with T-cell lymphoma, accurate subclassification may have been problematic. Fifty of the 266 patients developed recurrences during the period of study. Ninety per cent of these were at sites amenable to FNA. Furthermore, the cytomorphology could have indicated whether transformation to a higher grade of lymphoma had occurred. Currently, FNA coupled with FCM is an under-utilized diagnostic technique which has great potential for the investigation of patients with both newly diagnosed and recurrent lymphoma.
Subject(s)
Biopsy, Needle/standards , Flow Cytometry/standards , Lymphoma, Non-Hodgkin/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Biopsy, Needle/instrumentation , Biopsy, Needle/methods , Child , Diagnosis, Computer-Assisted , Evaluation Studies as Topic , Female , Flow Cytometry/methods , Hospitals, Special , Humans , Incidence , Lymphatic Metastasis , Lymphocyte Subsets , Lymphoma, Non-Hodgkin/classification , Lymphoma, Non-Hodgkin/epidemiology , Male , Middle Aged , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/epidemiology , Neoplasm Recurrence, Local/pathology , Neoplasm Staging , Ontario/epidemiology , Prospective Studies , Retrospective Studies , Sensitivity and SpecificityABSTRACT
Congenital malformations of the vestibular labyrinth (pars superior) are rare. We present two patients with computed tomographic findings of bilateral semicircular canal aplasia with normal or near-normal cochleas. Initial bone conduction thresholds were within normal limits, although both patients had significant conductive hearing losses due to congenital middle ear malformations. Bithermal caloric responses were absent in both. To our knowledge these are the first reports of vestibular aplasia concomitant with normal or near-normal cochlear development. These findings conflict with conventional hypotheses that state that inner ear malformations result from arrested development during the normal stages of inner ear embryogenesis.
