Esophageal perforations after anterior cervical surgery.

An esophageal perforation after anterior cervical surgery is an uncommon but well recognized complication. During the past 25 years, 44 patients have presented to Craig Hospital (Rocky Mountain Regional Spinal Injury Center) with esophageal perforations; this is the largest series reported to date. There were 34 patients whose esophageal injury was related to the operations performed for cervical fractures, of which 28 patients had plate and screw fixation. The most frequently occurring clinical symptoms were that of neck and throat pain, odynophagia, dysphagia, hoarseness, and aspiration. The most common clinical findings were an elevated temperature, localized induration and neck tenderness, crepitus or subcutaneous air in the neck and anterior chest wall, an unexplained tachycardia, and blood in the nasogastric tube. Imaging studies indicated an esophageal injury in only 32 (72.7%) patients. Twenty-two patients experienced cervical osteomyelitis or an abscess of the neck. Nonoperative treatment is fraught with a high mortality, and 42 patients required surgical repair of their esophageal injury. The length of hospital stay averaged 253 days. Successful management of esophageal perforations depends on the physicians' awareness of the causes, prompt recognition of the symptoms and clinical findings, and immediate institution of treatment.

Oesophageal trauma in patients with spinal cord injury.

Oesophageal perforations associated with cervical fractures occur from a variety of injuries. Fractures of the cervical spine, blunt trauma and penetrating injuries such as gunshot wounds, knives and missiles, perforate the cervical oesophagus. This retrospective study consists of 24 patients with an oesophageal perforation and cervical fracture. Motor vehicle accidents were responsible for 54% of the oesophageal perforations. The other oesophageal injuries were related to anterior spine surgery, gunshot wounds and sports-related activities. The clinical features related to these injuries included the obvious signs of an oesophageal perforation as well as fever of unknown origin, leukocytosis and unexplained persistent tachycardia. A variety of techniques was used to establish the diagnosis. All the patients had treatment for the cervical fracture and 20 patients required surgical repair of the oesophagus. The most common oesophageal complications were stricture of the oesophagus (54%) and oesophageal diverticulum (10%). The other complications were atelectasis, pneumonia, tracheobronchitis, pulmonary embolism, cervical osteomyelitis, cervical abscess, mediastinitis, septicemia and cervical fistulae. These patients have a serious life-threatening illness that may be difficult to diagnose and treat.

Histopathology and immunofluorescent immunoglobulins in asthmatics with aspirin idiosyncrasy.

Nearly 700 specimens of polyps and sinus tissues from 12 patients with asthma and aspirin idiosyncrasy were studied with histochemical and immunofluorescent immunoglobulin techniques. Hematoxylin-eosin, Giemsa, and Wright's stains were used for the histochemical analyses. Immunofluorescent antibodies for IgG, IgA, IgM, IgE, IgD, anti-C3, albumin, and fibrin were used. There was a uniform inflammatory reaction in all the tissues. A thick basement membrane and epithelial changes were also present. Immunofluorescent immunoglobulins were consistent in quantity and location in these tissues. IgG, IgA, and IgM were associated with inflammation. IgE was present in all the specimens, but this does not necessarily indicate a reagin-mediated reaction. Anti-C3 excluded the possibility of a hereditary absence of C1 esterase inhibitor.

Glottic and tracheal stenosis in spinal cord injured patients.

Between 1965 and 1985, 47 cases of glottic and/or tracheal stenosis were diagnosed at the Rocky Mountain Regional Spinal Cord Injury System. A retrospective review of medical records identified associated injuries, pulmonary and other medical complications in this patient population. Radiographic and endoscopic reviews utilised a grading system to classify the severity of stenosis. The clinical symptoms of stenosis were multiple, including dysphonia, aspiration, dysphagia, odynophagia, dyspnea and excessive secretions. The wide spectrum of treatment modalities included endoscopy with excision and/or dilation, general medical management, steroids, radiation therapy, intubation, stent insertion and surgical repair of the stenotic area. Outcome status was reviewed and suggestions provided for the early diagnosis and treatment of this potentially life-threatening condition.

Nasal polypectomy and sinus surgery in patients with asthma and aspirin idiosyncrasy.

This study attempted to determine whether or not nasal and sinus surgery had a beneficial or deleterious effect upon the asthma of patients with nasal polyps and aspirin idiosyncrasy. There were 205 patients in this study. A classification system was devised to provide a means of determining the severity of asthma before and after surgery. The data indicate that surgery does improve the patient's asthma for relatively long periods of time.

Colloid cyst causing rhinorrhea.

A case of nontraumatic cerebrospinal fluid (CSF) rhinorrhea secondary to obstruction of the flow of cerebrospinal fluid by a colloid cyst is reported. Only 1 other case of CSF rhinorrhea secondary to a colloid cyst has been reported. A review of the world literature reveals 33 cases of CSF rhinorrhea secondary to obstruction of flow of cerebrospinal fluid.

Treatment of perennial rhinitis with flunisolide corticosteroid spray.

Flunisolide nasal spray was compared to its propylene and polyethylene glycol vehicle in a randomized double-blind study of 20 adult patients with perennial rhinitis. After a two-week baseline period patients received either active flunisolide 50 microgram q.i.d. or placebo for four weeks. Laboratory studies included serum 8 a.m. cortisols, nasal air-flow measurements and nasal smears for eosinophils and fungi. Patients kept daily symptom diaries. There was no difference between active and placebo groups for sneezing, runny nose or nose blowing. Although post-nasal drip showed the greatest improvement in the active group, there was a trend for improvement in both groups. By the second week the percentage of eosinophils on nasal smear significantly decreased in both groups. Nasal air-flow measurements also showed improvement in both active and placebo groups. There was no change in serum cortisol levels compared to baseline. Side effects were similar in both active and placebo groups. Although no positive fungal cultures were obtained during the double-blind study. Candida was cultured during the long-term program in one patient.