Lymphadenopathy in the HIV-seropositive patient.

The problem of lymphadenopathy in HIV-seropositive patients is reviewed, and indications for further study are presented. Implications for patients who later develop AIDS are discussed.

Penetrating injuries involving the anterior cranial fossa.

Penetrating injuries of the anterior cranial fossa may result in permanent neurologic changes or even death if injuries are unrecognized and remain untreated. The diverse etiologies of such injuries are reviewed, as well as their diagnosis, treatment and prognosis.

A traditional approach to surgery of the tonsils and adenoids.

Current indications and contraindications for tonsil and adenoid surgery are discussed and the surgical techniques used are reviewed. A philosophy for managing patients is presented.

Reconstruction of a mandible after shotgun trauma: report of case.

A case of massive facial trauma secondary to a shotgun injury has been presented. The method for managing soft tissue and bony defects incurred is discussed, and a method for reconstruction of the mandible with both an alloplastic implant and autogenous bone graft is detailed.

Management of the airway in patients with angioedema.

Angiodema can be frequently encountered in clinical practice, and usually represents transient areas of tissue edema and erythema. In general, lesions involve the deep dermis as well as subcutaneous or submucosal sites and can affect multiple organ systems, including the respiratory and gastrointestinal tracts. Although the underlying cause for the angioedema is frequently not known, it can result from atopy, specific antigen sensitivities, physical stimuli, as well as disorders that affect the complement cascade. These latter entities may be congenital or acquired. Pathogenesis for angioedema is generally thought to be activation of mast cells or basophils, with subsequent release of histamine and other mediator products which can induce inflammatory changes. In most patients with physical and allergic causes of angioedema, swelling can usually be treated with epinephrine, antihistamines and/or steroids. Management of the airway in such patients is usually symptomatic, although certain patients require hospitalization for supervised care. On the other hand, patients with hereditary angioedema do not often respond well to these agents. In such patients, we currently add infusions of epsilonaminocaproic acid as well as nembulized racemic epinephrine to our therapeutic regimen, but even this may not be satisfactory. At the National Institute of Allergy and Infectious Disease, endotracheal intubation is usually preferred to tracheostomy for securing a temporary airway, though certain patients may require placement of tracheostomies for better control of the airway. Patients with frequent recurrences of airway obstruction are rarely seen--even among those patients with known hereditary angioedema. However, such patients may require tracheal fenestrations to secure long-term protection of the airway. The Institute's experiences in the management of patients with angioedema are reviewed, and therapies employed are described.

Ear disease in patients with Wegener's granulomatosis.

From a group of 60 patients with histologically-proven Wegener's granulomatosis managed at the National Institute of Allergy and Infectious Disease, approximately 45% were found to have disease that involved the ears. The majority of these patients had either recurrent or persistent serous otitis, resulting from eustachian tube dysfunction as a consequence of nasopharyngeal inflammations. Other pathologies included suppurative otitis, cholesteatoma, facial nerve paralyses, temporal bone granulomata, and sensory hearing losses. The presentation and management of these changes and their relationships to underlying disease are described in selected case reports, and a general philosophy of patient management is presented.

Recurrent cementifying fibroma of the jaws.

The cementifying fibroma is a benign fibro-osseous tumor of the jaws, and is generally believed to originate from the periodontal ligament. The tumor commonly presents as an asymptomatic mass lesion, and is usually well-circumscribed clinically so that conservative excisions have been the treatment of choice. From 1970-1980, 94 cases of cementifying fibromas involving either the maxilla or the mandible were accessioned by the Tumor Registry of the Armed Forces Institute of Pathology. Recurrences were found in 11 of these cases, of which 6 involved the mandible. Experiences with these cases are described, as well as experiences with two patients who were managed at the National Naval Medical Center and National Institutes of Health. Conclusions indicate that preferred management for most recurrent cementifying fibromas involves conservative removals which attempt to preserve form and function of the affected site. Residual disease when unavoidable often remains quiescent for extended periods of time without compromise to the patient involved.

Squamous carcinoma of the uvula.

From a study of the clinical courses of nine patients with squamous carcinoma of the uvula and a review of the clinical literature involving such lesions, we have concluded that these tumors have a very poor prognosis when metastases occur, despite seemingly adequate initial therapy to the primary tumor. Consequently, we believe that more aggressive treatment (which may include irradiation of even subclinically involved neck nodes) should be considered.