Voice restoration after total laryngectomy with tracheoesophageal puncture and voice prosthesis

Removal of the voice box or larynx is the usual treatment for advanced cancer of the larynx. Tracheoesophageal puncture (TEP) has become an accepted method for voice restoration following total laryngectomy. Eleven patients under went total laryngectomy with TEP at San Pablo Hospital Medical Center between March 1989 and October 1995. Seven patients were available for voice analysis. Eighty six percent of the patient was able to talk. This is the first report of TEP being perform in Puerto Rico and with a complete Hispanic population of patients. Results compare favorably with those reported in the medical literature

Efficacy of ceftibuten for pediatric patients undergoing adenotonsillectomy

A survey between Otolaryngologist Head and Neck Surgeons in Puerto Rico and a prospective study was done, to evaluate the efficacy of ceftibuten in pediatric patients undergoing adenotonsillectomy. Surgery of the tonsils and adenoids is the most common operation performed in the pediatric age by the Otolaryngologist Head and Neck Surgeons in Puerto Rico. Over 70 are performed in a ambulatory setting and almost all of the patients are given antibiotics after surgery. Ceftibuten was given to 112 pediatrics patients after surgery. Adenotonsillectomy is a painful operation and children do not take medication well after surgery. One of the benefits of this third generation cephalosporin, is that is given once a day. Twenty events were reported taking the medication, but only seven patients had to discontinue its use. Ceftibuten had a tolerance rate of 94. Ceftibuten seems to be a safe antibiotic to use in pediatric patients undergoing adenotonsillectomy and has the convenience of being given once a day

Efficacy of ceftibuten for pediatric patients undergoing adenotonsillectomy.

A survey between Otolaryngologist Head and Neck Surgeons in Puerto Rico and a prospective study was done, to evaluate the efficacy of ceftibuten in pediatric patients undergoing adenotonsillectomy. Surgery of the tonsils and adenoids is the most common operation performed in the pediatric age by the Otolaryngologist Head and Neck Surgeons in Puerto Rico. Over 70% are performed in a ambulatory setting and almost all of the patients are given antibiotics after surgery. Ceftibuten was given to 112 pediatrics patients after surgery. Adenotonsillectomy is a painful operation and children do not take medication well after surgery. One of the benefits of this third generation cephalosporin, is that is given once a day. Twenty events were reported taking the medication, but only seven patients had to discontinue its use. Ceftibuten had a tolerance rate of 94%. Ceftibuten seems to be a safe antibiotic to use in pediatric patients undergoing adenotonsillectomy and has the convenience of being given once a day.

Voice restoration after total laryngectomy with tracheoesophageal puncture and voice prosthesis.

Removal of the voice box or larynx is the usual treatment for advanced cancer of the larynx. Tracheoesophageal puncture (TEP) has become an accepted method for voice restoration following total laryngectomy. Eleven patients under went total laryngectomy with TEP at San Pablo Hospital Medical Center between March 1989 and October 1995. Seven patients were available for voice analysis. Eighty six percent of the patient was able to talk. This is the first report of TEP being perform in Puerto Rico and with a complete Hispanic population of patients. Results compare favorably with those reported in the medical literature.

Differences in membrane ion transport between hepatocytes from the periportal and the pericentral areas of the liver lobule.

We studied the Na+/K+ pump, Na+/K+ ATPase activity, and oxygen consumption (QO2) in hepatocytes isolated from the periportal (PH) and pericentral (CH) regions of the liver lobule, to provide an insight into the functional properties of these cells. Na+/K+ pump activity was determined using 86Rb+ (a functional analog of K+) and ouabain, a specific inhibitor of this transport system. Our results indicate the the Na+/K+ pump and Na+/K+ ATPase activity are significantly lower in CH than in PH, although basal ouabain-sensitive (OS) QO2 was negligible in both of these cell preparations. However, OSQO2 was significantly lower in CH than in PH when the Na+/K+ pump was activated using the ionophore nystatin in a Na(+)-containing medium. These results indicate that the differences in membrane ion transport exist between hepatocytes from different locations of the liver lobule.

Changing trends in adenotonsillectomy at San Pablo Hospital 1983 vs. 1993.

The purpose of this paper is to review the changing trends in Adenotonsillectomies performed in San Pablo Medical Center during the last ten years. We have reviewed using a 25 variable questionnaire all patients undergoing this surgical procedure during the first six months in 1983 and compared the information with the patients having this procedure during the first six months of 1993. We conclude that the number of interventions, the indications, prior medical history and cost effects have changed substantially. Our data supports the accuracy of some of the trends being reported in the literature regarding this surgical intervention.

Metastatic melanoma to the facial nerve.

Isolated metastatic malignant melanoma to the facial nerve has never been reported. This presentation illustrates a primary melanoma of the helix of the ear that was treated by excisional biopsy and then wedge resection in 1983. The primary melanoma was Clark's level IV and 1.3 mm in thickness. In 1985, a facial paresis slowly developed. There was no gross evidence of recurrent melanoma in the ear or neck, but CT scan showed a mass in the region of the stylo mastoid foramen. A reoperation of the primary site revealed metastatic melanoma in the facial nerve, expanding it to approximately 10 times its normal size. A composite resection was done for the melanoma, and the paralyzed face was immediately rehabilitated by a masseter muscle transfer. The patient received 6000 rads to this area postoperatively and has remained free of disease to date, having returned to his profession as a dentist. A detailed study of all the specimens indicated that this represented a primary metastasis to the facial nerve.

Foreign bodies of the esophagus the San Pablo Hospital experience.

Between 1978 and 1990, a total of 76 cases of esophageal foreign bodies were taken to the operating suite at San Pablo Hospital. Of the 76 patients, 26 were in the pediatric age group, and 56 adults. Dysphagia and foreign body sensation were the predominant complaint. The radiographic study most frequently ordered was soft tissue neck x rays. Coins were the most common foreign body in the pediatric group, while bones were the most frequent in the adult group. Rigid esophagoscopy was the predominant form of treatment in both groups. The majority of cases were performed by the Otolaryngologist-Head and Neck Surgeon. Several complications occurred and there was one death. For the purpose of analysis and discussion the cases were divided into the pediatric age group and the adults.

Overview of results with tracheoesophageal puncture after total laryngectomy.

Ten years have passed since the introduction of the tracheoesophageal puncture. The voice restoration field has dramatically changed upon the introduction of this new technique. This permits the patients to speak as early as ten days after surgery. An overview of the results of the past ten years are presented. In this communication the technique, historic highlights, and the published experience with tracheoesophageal puncture as a secondary, primary and in extended laryngopharyngectomy with flap reconstruction are discussed. Tracheoesophageal puncture with placement of voice prosthesis for voice restoration after total laryngectomy, has become an accepted technique. The popularity of this method originally proposed by Singer and Blom has been widespread. This new method of vocal rehabilitation after total laryngectomy, has permitted patients to speak as early as ten days after their surgery. This is a great advance in the rehabilitation of the cancer patient.

Tracheoesophageal puncture for voice restoration after extended laryngopharyngectomy.

Tracheoesophageal puncture was performed in ten of our patients undergoing extended laryngopharyngectomy. Three fistulas were allowed to close, and two patients were dissatisfied with their results, which allowed for an overall 50% success rate in this subgroup. The resultant voice was objectively compared with similar groups of patients undergoing primary and secondary tracheoesophageal puncture after standard laryngectomy. There was no significant difference in maximum phonation time, average speaking intensity, and average fundamental frequency between these groups. However, the maximum intensity and average intensity were significantly lower for the flap group. Our results indicate that tracheoesophageal puncture should be attempted in patients undergoing the extended procedure, notwithstanding a lower expected success rate.

Congenital cholesteatomas in children: an embryologic correlation.

The clinical findings in 37 children with congenital cholesteatoma of the middle ear, 17 of which have not been previously reported, are presented. Clinical findings and surgical observations are correlated with recent developmental studies. It is hypothesized that congenital cholesteatoma may originate from an epidermoid formation, which has been identified in the anterior superior lateral tympanic cavity adjacent to the anterior annulus during fetal development, and which normally is present early in development, involuting by 33 weeks' gestation. It is proposed that the epidermoid formation may not always involute, and could serve as an embryologic anlage of congenital cholesteatomas.

Muscle capillarity in rats with increased blood oxygen affinity.

To investigate the effects of low P50Hb on muscle capillarity, rats were injected with Na-cyanate (50 mg/kg BW) every day for 2 or 4 weeks (experimental). Controls received injections of saline. After 2 weeks P50 was reduced in the experimental animals (20.4 vs 30.3 Torr). After 4 weeks experimental animals showed a 13% increase in hematocrit and Hb. PVO2 was lower in experimental than in control rats (28.3 +/- 1.0 vs 33.8 +/- 4.7 mm Hg). Fiber cross-sectional area (FCSA), capillary density (CD) and capillary-to-fiber ratio (C/F) were measured in sections treated with the ATPase technique. FCSA was smaller in experimental than in controls (3000 +/- 491 vs 4121 +/- 415 micron 2 for the soleus and 3633 +/- 236 vs 4251 +/- 194 micron 2 for the gastrocnemius) and CD was higher (729 +/- 99 vs 578 +/- 75 cap/mm2 in the soleus and 388 +/- 19 vs 323 +/- 14 cap/mm2 in the gastrocnemius) but C/F was not different. Diffusion distances for O2 measured by the closest individual method were not significantly different between the two groups. The higher CD in the experimental animals seems to be the result of their smaller FCSA and not the result of capillary proliferation. The volume of tissue served by a capillary was significantly reduced in the experimental animals. This could help the transfer of O2 to the muscle in animals with a low P50 Hb.

Cholesteatoma in the pediatric age group.

The diagnosis and management of cholesteatoma in children remains controversial. In the past 15 years, the senior author (S.C.P.) has treated 320 patients with cholesteatoma. Patients 18 years and younger composed 40% (125) of the overall group and are the basis for this report. The patient data were compiled using the history, physical examination, audiograms, radiographs, patient questionnaires, surgical findings, and postoperative observations. The surgical treatment selected was determined by the extent of disease, the configuration of the mastoid, and a clinical assessment of eustachian tube function. A middle ear tympanotomy approach was used in 17% of the patients, a canal wall up procedure in 31%, and a canal wall down procedure in 52.3%. The average clinical follow-up was 3.9 years, with the range being from 3 months to 13.5 years. Hearing was maintained or slightly improved in a majority of cases. Residual disease occurred in 8% of patients, and recurrent disease in only 3%.

Primary tracheoesophageal puncture for voice restoration.

A 93 percent success rate of voice restoration after primary tracheoesophageal puncture was achieved in 15 patients. Patients were usually able to talk within 3 weeks after laryngectomy. Male patients without chronic obstructive lung disease achieved better results. The incidence of complication after this procedure were not significantly different from a group of 111 patients who underwent laryngectomy alone. Finally, early speech acquisition provides a substantial psychologic boost for the patient undergoing total laryngectomy.

A review of twenty congenital cholesteatomas of the middle ear in children.

Cholesteatomas, arising within the middle ear space behind an intact tympanic membrane, have been detected more frequently in recent years. This article reviews 19 children (with a mean age of 4.3 years) who underwent surgery over a 7-year period for removal of cholesteatomas from behind intact tympanic membranes. Most of these children were referred by pediatricians who had detected an asymptomatic whitish middle ear mass. Many had histories of treatment for otitis media. Patients with similar histories were excluded from the series if there had been a prior perforation, myringotomy, or otologic surgery. In the series, one fourth of the children had associated congenital malformations, and there were 3 times as many boys as girls. In two thirds of the cases, the cholesteatoma was manifested as an anterior-superior middle ear mass that seemed to arise from the processus cochleariformis, undersurface of malleus area. Many could be removed via an extended anterior tympanotomy operative approach. The results of surgery are reviewed. The possible origins of these localized cholesteatomas are considered. Are they congenital defects that arise from misplaced keratinizing epithelium? Do they arise from mesenchymal cells whose differentiation is stimulated by inflammatory changes within the middle ear?