Caustic esophageal lesions in childhood: prevention of stricture formation.

Accidental caustic ingestion, a problem of childhood, can lead to esophageal stricture formation. We studied 132 children less than 19 years of age who were admitted to our hospital for suspected caustic ingestion. Forty-nine had burns in the esophagus, 11 of whom had deep and circular burns and were therefore prone to developing esophageal strictures. Only these 11 children were treated for prevention of stricture formation with a special nasogastric tube, functioning as intraluminal stent; this was their sole treatment. No corticosteroids were used. Only one of the 11 developed mild stenosis. In none of the other untreated children was stricture formation observed. Therefore, we believe that this approach spares many children unnecessary treatment and hospitalization, that our nasogastric tube effectively prevents stricture formation, and that there is no need for the use of corticosteroids in the treatment of caustic esophageal lesions in childhood.

Role of high-frequency audiometry in the early detection of ototoxicity. II. Clinical Aspects.

As a supplement to a previous paper [Dreschler et al.: Audiology 1985; 24:387-395] high-frequency (HF) audiometry was applied to compare the ototoxic effects of two different drug administration protocols for cis-platinum (CDDP). In both subgroups, HF audiometry considerably enhanced the early detection of ototoxicity. Marked differences between treatments have been established both in the pattern of onset of the damage and in the relation between dose and damage severity. For subjects treated with platinum derivatives, the thresholds at 12 and 14 kHz prove to be especially important. The results suggest that for these subjects the measurement of only a single frequency may be considered: with a minimum of effort, most of the increased sensitivity for a complete HF audiogram can be obtained. Finally, the relation between threshold deteriorations above 8 kHz and threshold deteriorations in the conventional range of audiometric frequencies has been investigated.

Facial growth in the rabbit after autologous grafting in unilateral clefts.

In each of 39 rabbits, a left-sided cleft of the lip and alveolar part of the maxilla were made by removal of the premaxillomaxillary suture. In 5 animals, the cleft was left unrepaired. In 12 animals, an autologous graft from the mandibular symphysis was introduced, and in 12 animals autologous rib-growth cartilage was used for grafting. Lateral photographs of adult skulls in a standardized position were made, and a computerized craniometric analysis of the position of 13 anatomic landmarks in an orthogonal coordinate system was performed. The data from the grafted skulls (12) were compared with those from the control series (20) and subjected to a multivariate analysis, according to Hotelling. Comparison of the grafted adult skulls with 20 unoperated controls and the animals with unrepaired artificial clefts revealed that introduction of rib-growth cartilage leads to an improvement with respect to the growth of the facial skeleton. The initial orientation of the graft in the cleft appeared to be important for its integration in the jaw.

High frequency audiometry in prospective clinical research of ototoxicity due to platinum derivatives.

The results of clinical use of routine high frequency audiometry in monitoring the ototoxic side effects of platinum and its derivatives are described in this prospective study. After demonstrating the reproducibility of the technique, we discuss the first results of an analysis of ototoxic side effects in 75 patients (150 ears). Significant differences in the pattern of hearing loss were registered for the different platinum treatment groups (cisplatin 20 mg/m2, cisplatin 50 mg/m2, and carboplatin 350 mg/m2). In the groups receiving cisplatin 50 mg/m2 and carboplatin 350 mg/m2, 42% and 25%, respectively, of the investigated ears proved to be undamaged, versus 9% undamaged in the group receiving cisplatin 20 mg/m2 (p less than .01). Ototoxic hearing loss started mainly (46% to 70%) in the higher frequencies (10,000 to 18,000 Hz) and developed into a broader-range hearing loss (1,000 to 18,000 Hz) during treatment in 13% to 43% (p less than .01). The onset of hearing damage was influenced by the patient's age (p less than .001) and the existence of a troubled otologic history (p less than .05). The study demonstrates the important role of high frequency audiometry in early detection and monitoring of ototoxic damage.

Inspiratory stridor and dysphagia because of prolonged oesophageal foreign body.

A 2-year-old boy with severe inspiratory stridor and dysphagia is described. The delay in the diagnosis of an impacted foreign body resulted in severe deformation of the oesophagus. After surgical extraction of the foreign body the oesophagus was splinted for 4 months by a nasogastric tube because of persistent severe dysphagia. Removal of this tube was followed by a gradual disappearance of the complaints.

The role of high-frequency audiometry in early detection of ototoxicity.

Ototoxicity is one of the unwanted side-effects of a number of medical drugs. As ototoxicity appears to be most pronounced in the higher frequencies, it can be assessed at an earlier stage by using high-frequency audiometry from 8 to 20 kHz. We have investigated the precision of these measurements. In spite of inaccuracies of headphone positioning, which may influence especially the high-frequency thresholds, standard deviations for frequencies above 8 kHz were obtained that were nearly as small as for audiometry up to 8 kHz. Age-related reference curves for the higher frequencies are presented. The results on 100 ears of patients treated with platinum-derivatives show the importance of high-frequency audiometry for the early detection of ototoxicity.

The influence of partial resections of the nasal septal cartilage on the growth of the upper jaw and the nose: an experimental study in rabbits.

After birth the facial skeleton grows more, and over a longer period, than the neurocranium. The facial skeleton shows an extra growth in comparison with the latter. In young rabbits the dorso-ventral continuity of the septal cartilage was interrupted by various partial resections. It appeared that a discontinuity of the septal cartilage does not prevent all growth of the nose and maxilla but interferes with their extra growth, in particular the lengthening of the nose and the upper jaw and the postnatal ventral displacement of the molar complex and maxilla.

The effects of septal surgery on the growth of nose and maxilla.

Experiments in growing rabbits showed the great importance of the nasal septum for the postnatal growth of the facial skeleton. The influence of surgical procedures on the morphogenetic function of the nasal septum was investigated. The effects of unilateral and bilateral elevation of the mucoperichondrium and of submucous resection of various parts of the septal cartilage on the growth of the nose and upper jaw are demonstrated.

Growth mechanisms in skulls with facial clefts. Descriptive and experimental studies on the facial skeleton.

During postnatal growth, skulls of patients with untreated unilateral clefts of the alveolus and palate develop additional anomalies of the facial skeleton. Similar anomalies--a deviation of the upper jaw to the non-cleft side and retropositioning of the maxilla on the cleft side--develop in rabbits with the same type of cleft, surgically produced in the fourth week after birth. Based on a quantitative study of the postnatal growth of the rabbit skull under normal and various experimental conditions, a mechanisms is proposed for the late developement of anomalies of the facial skeleton in cleft-affected skulls.

Skulls with facial clefts. Experimental surgery on the facial skeleton.

Skulls of adult, unoperated patients with facial clefts show additional anomalies specific for the type of cleft. In an experimental study we demonstrated that similar anomalies develop in rabbits with clefts that are artificially made in the fourth week after birth. Some surgical methods (Veau, primary osteoplasty) for correction of facial clefts are compared with regard to their effect upon later growth of the skull of young rabbits. The importance of experimental surgery preceding the introduction of new surgical techniques on the growing skull and its facial skeleton in particular is stressed.