ABSTRACT
The purpose of this study is to support the hypothesis that diabetic end-organ damage of the cochlea is augmented in the setting of hypertension. A historical perspective reviewing the effects of diabetes and hypertension as causative factors in the development of sensorineural hearing loss, as well as the basic epidemiology and pathophysiology of the renal and vascular effects of diabetes and hypertension, is presented. The results of audiologic findings in insulin-dependent diabetic patients, both normotensive and hypertensive, were analyzed and correlated with the results of animal studies to support the hypothesis that sensorineural hearing loss in patients and cochlear hair cell loss in animal studies result from the effects of hypertension in conjunction with insulin-dependent diabetes mellitus.
Subject(s)
Diabetes Mellitus, Type 1/complications , Hearing Loss, Sensorineural/etiology , Hypertension/complications , Adult , Aged , Arteriosclerosis/complications , Audiometry, Pure-Tone , Cochlea/pathology , Cochlear Diseases/complications , Cochlear Diseases/pathology , Diabetes Mellitus, Type 1/epidemiology , Female , Glomerulonephritis, Membranous/complications , Glomerulonephritis, Membranous/pathology , Hair Cells, Auditory, Outer/pathology , Hearing Loss, Sensorineural/diagnosis , Humans , Hypertension/epidemiology , Male , Middle Aged , Speech Reception Threshold TestABSTRACT
INTRODUCTION: The incidence of carcinoma arising in a pleomorphic adenoma is reportedly between 1.4% and 6.3%. Malignant degeneration is often associated with a prolonged history of untreated or recurrent pleomorphic adenoma. MATERIALS AND METHODS: Two patients with malignant parotid carcinoma that arose from benign pleomorphic adenoma are reviewed. RESULTS: Both patients exhibited a prolonged history of pleomorphic adenoma apparently persistent after initial inadequate surgery. Surgeries were performed 37 and 12 years before development of malignancy. DISCUSSION: The phenomenon of malignant carcinoma arising from benign pleomorphic adenoma is an important issue. The occurrence of these malignant carcinomas emphasizes that aggressive treatment of primary and recurrent mixed tumors is necessary.
Subject(s)
Adenocarcinoma/pathology , Neoplasms, Germ Cell and Embryonal/pathology , Neoplasms, Second Primary/pathology , Parotid Neoplasms/pathology , Adenocarcinoma/diagnosis , Adenocarcinoma/surgery , Adult , Female , Humans , Male , Middle Aged , Neck Dissection , Neoplasms, Germ Cell and Embryonal/diagnosis , Neoplasms, Germ Cell and Embryonal/surgery , Neoplasms, Second Primary/diagnosis , Neoplasms, Second Primary/surgery , Parotid Neoplasms/diagnosis , Parotid Neoplasms/surgeryABSTRACT
Many methods of speech rehabilitation after total laryngectomy have been attempted and abandoned. As experience increased with the tracheoesophageal puncture technique, we found it to be a reliable and reproducible form of speech rehabilitation when certain criteria are met. This study reviews our experience and analyzes the reasons for failure in those populations. Factors analyzed include the evidence of hypopharyngeal stenosis, patient education, XRF, and the flanged prosthesis versus the nonflanged prosthesis. The indications for this type of speech rehabilitation procedure are presented based on our findings.
Subject(s)
Esophagus/surgery , Laryngectomy/rehabilitation , Larynx, Artificial , Trachea/surgery , Consumer Behavior , Humans , Prosthesis Design , Punctures/adverse effects , Punctures/methods , Time Factors , Wound Infection/etiologyABSTRACT
Hypopharyngeal stenosis after total laryngectomy is a relatively frequent complication. In our series we found that approximately 20% of total laryngectomies require treatment for hypopharyngeal stenosis. This presentation analyzed the factors that contribute to hypopharyngeal stenosis in a large series of patients treated at Emory University and affiliated hospitals. Analysis is presented on the effects of location of the cancer, extent of resection, radiation therapy, and methods of reconstruction. The highest incidence of hypopharyngeal stenosis was found in hypopharyngeal vs. endolaryngeal lesions. The surgical decision examined in this paper is whether a primary "tight closure" of the hypopharynx or a flap or graft reconstruction gives the best results with the lowest complication rate. The best treatment of hypopharyngeal stenosis is its prevention. This paper deals with the methods of identifying the surgical situation when one is most apt to have stenosis and suggest appropriate measures to prevent these complications.
