Alan M. Nahum

Surgical management of the thyroid nodule: patient selection based on the results of fine-needle aspiration cytology.

To determine whether the routine use of fine‐needle aspiration (FNA) cytology reduces the rate of unnecessary surgery, the surgical pathology of 54 thyroidectomy patients who had preoperative FNA was compared to the results obtained with 24 thyroidectomy patients who did not have preoperative FNA.

An Experimental Model for Closed Head Impact Injury

A series of blunt head impacts has been performed on stationary unembalmed human cadavers. The specimens were prepared to simulate realistic fluid pressures within the cerebrospinal fluid space and cerebral blood vessels. Translational acceleration-time histories of the head were recorded by biaxial accelerometers attached to the skull. Peak resultant head accelerations in excess of 3,000 m/s**2 and pulse durations of 5 ms. or less were observed in a series of 10 experiments. The cerebral vascular system, careful gross and microscopic pathologic studies of the cranial soft tissues were performed to assess vascular hemorrhage as represented by extravasation of tracer solution into the brain tissue. Data is presented describing the input forcing function, resultant head acceleration, and detailed necropsy findings.

The case for elective prophylactic neck dissection

The possibility of improving the cure rate of cancer of the head and neck by radical neck dissection of the clinically negative neck (elective neck dissection) continues to pose a therapeutic dilemma. This paper seeks to review the available information, analyze relevant aspects of the issue and attempt to draw conclusions which will be helpful both to physicians and their patients. The discussion is confined to squamous carcinoma of the larynx, pharynx, and oral cavity

Frozen section diagnosis: Accuracy and errors; uses and abuses

In a series of 2,665 frozen sections, false‐positive diagnoses of cancer occurred only four times (0.15 percent) and false‐negative diagnoses of cancer 43 times (1.61 percent). In 46 instances, the diagnosis had to wait for paraffin sections.

Medial Orbital Wall Fracture With Rectus Entrapment

Two cases of medial orbital fracture with medial rectus muscle entrapment are reported, one a bona fide blowout fracture. Review of the literature reveals six previous cases. Clinically, patients complain of diplopia with lateral gaze and forced duction tests confirm medial rectus entrapment. Radiographic confirmation is best obtained with hypocycloidal tomography. Surgical therapy is indicated for diplopia or enophthalmus.

Injury mechanisms in rollover collisions

This paper presents conclusions of a study of rollover collisions and the injuries resulting from them. The injury severity, the type of injury, the body region injured, the frequency of injury, and the injury mechanism are all indicated. The study includes statistics on both restrained and unrestrained occupants, and shows that ejected occupants usually sustain more severe injury than contained occupants. Several conclusions are presented as to automobile structures in relation to injury.

Microscopic controlled excisions for epidermoid carcinoma of the head and neck.

A concept for microscopic frozen section control of head and neck primary cancers is described. Skilled application of these principles should significantly increase local control of epidermoid carcinoma of the upper aerodigestive tract.

Experimental studies of side impact to the human head

In an ongoing effort to develop an accurate model of human head impact relationships, two series of impacts were performed on the side of a human cadaver head at the junction of the temporal and parietal bones. When four sequential impacts were performed on a single embalmed specimen, a good correspondence was found between peak head acceleration and Head Injury Criterion, and the adequacy of instrument placement and data analysis was confirmed. Five impacts on individual unembalmed cadavers indicated that side impacts produced pressure gradients in the brain. These superimposed gradients were proportional to the magnitudes of the head acceleration components, the largest of which was in the direction of impact and produced positive pressures near the impact and negative ones opposite the impact. A pressure-limiting mechanism acted on the side of the brain opposite the impact. Subarachnoid hemorrhages occurred on the high stress and strain brain surfaces. Approximate values for the pressures were determined in computer simulations. Changes in the model and instrumentation are needed to improve the accuracy of the computed pressures. The acceleration traces contained vibration or noise which made calculation of rotation acceleration and velocity impossible. A better representation of the midsaggital sinus is needed.

Biomechanics of Bone

Bone is a dynamic, living tissue. As a material as well as a structure, it is in a constant state of flux. Consequently, the ability of bone to resist an applied load before failure or fracture is dependent on multiple factors. Age, disease, hormone levels, too little load, too much load, or even the direction in which a load is applied can all influence the biomechanical properties of bone. In particular, the potential of the bone to resist fracture is affected by these physiologic and mechanical sources. This chapter defines the biomechanical properties of bone, first by explaining both its micro- and macroanatomic components, and second by describing how its structural and mechanical properties relate to this anatomy. A thorough understanding of this relationship allows one to consider how the aforementioned factors change the ability of bone to withstand an applied load.

Treatment of locally advanced squamous cell carcinoma of the head and neck with concurrent bleomycin and external beam radiation therapy

Abstract Nineteen patients with advanced head and neck cancer were treated with bleomycin (15u BM and irradiation (180 rad, 5d/week, 5040 rad) and have analyzed the effects. Most patients went on to further radical treatment. Both epithelial toxicity and tumor regression seemed enhanced. Approaching 1 year minimum follow-up (2 years maximum) crude survival is 68% and disease-free survival is 57%. Late complications do not seem to be enhanced. Regression in advanced nodal disease was less impressive.