Joseph P. Atkins

Complications of Intubation

Endotracheal intubation with current inert low-pressure, high-volume cuffed tubes is a safe procedure associated with few complications in the vast majority of patients. However, complications related to mechanical difficulties and mucosal injury can occur even under ideal circumstances. Immediate complications are primarily associated with problems during intubation and extubation while early and late complications represent the short- and long-term effects of epithelial trauma.

Control of epistaxis in patients with hereditary hemorrhagic telangiectasia.

Twenty-nine patients were admitted to Pennsylvania Hospital between March 1984 and July 1990 with a diagnosis of epistaxis and hereditary hemorrhagic telangiectasia. Data were obtained through a retrospective review of the charts of these patients. Patients were treated for epistaxis with the CO2 laser, neodymium:aluminum garnet laser with a wavelength of 1064 nm (Nd-Yag), Nd-Yag laser with a wavelength of 532 nm (KTP), septodermoplasty, or any combination of these procedures. Patients under-went an average of 2.5 procedures each. Overall, 25 of 29 patients reported their symptoms had greatly improved with therapy. The average length of time without the need for further surgical intervention was 16.3 months for the Nd-Yag laser and 11.7 months for the KTP laser. Septodermoplasty using buccal mucosal grafts allowed patients to avoid additional procedures for 24.4 months, which was twice as long as for standard septodermoplasty using split-thickness skin grafts. Although no therapy completely resolves the epistaxis, laser therapy combined with septodermoplasty enables the patients to gain excellent control of the epistaxis for several years.

Epidemiology of head and neck cancer.

Epidemiologic considerations which are pertinent to cancer of the head and neck are broad and varied. Cigarette smoking continues to be the major cause of head and neck neoplasms. Occupational and environmental exposures to carcinogens have been well identified. Tumors may develop as a result of medical therapies. Susceptibility on a genetic basis has been shown, and the role of viruses in carcinogenesis has been further documented.

Evaluation and Treatment of Frontal Sinus Fractures

We treated twenty-three patients with blunt or penetrating wounds of the frontal sinus from 1978 through 1983. Nondisplaced anterior wall fractures were observed or explored. Posterior table fractures—with displacement confirmed by computed tomography or polycycloidal tomography—were explored. Either obliteration of the sinus or nasofrontal duct reconstruction with a Sewall-Boyden-McKnaught flap was selected, depending on the magnitude of duct injury. In all cases, the anterior wall was primarily reconstructed. All penetrating wounds with posterior table involvement were treated by cranialization of the frontal sinus and temporalis muscle obliteration of the nasofrontal ducts. Only one case of meningitis occurred, resulting in prolonged hospitalization.

Transbronchial drainage of pulmonary abscesses with the flexible fiberoptic bronchoscope

Flexible fiberoptic bronchoscopy with multiplanar flouroscopic control is shown to be effective in the transbronchial drainage of pulmonary abscesses. A new technique which permits the intracavitary placement of brush forceps and fine arterial catheters is described. This has facilitated the rapid defervescence of fever and established immediate endobronchial drainage. Seventy percent of patients had complete radiographic closure of their abscess cavities at three months. Clinical findings are presented and the role of aspiration in pathogenesis of pulmonary abscess is stressed.

Acinic Cell Carcinoma of the Oral Cavity

A rare case of acinic cell carcinoma of minor salivary gland origin within the oral cavity is reported in a 62-year-old woman. These tumors most commonly arise in the parotid gland and follow an insidious course requiring long-term follow-up. The gross and histologic features of the patients tumor include pseudoencapsulation, mixed solid and acinar architecture, microcyst formation, and the presence of conspicuous diastase-fast and PAS-positive cytoplasmic granules, characteristic of lesions that have been called acinic cell carcinoma by a variety of authors. Surgical excision is the treatment of choice. However, following an incisional biopsy, the patient refused further surgical treatment and has remained clinically disease-free three years postoperatively.

Hypersomnia with Periodic Breathing (An Acromegalic Pickwickian)

The syndromes of Pickwickian, Ondines curse, and primary alveolar hypoventilation are respiratory disorders manifesting increased sleepiness and irregular respiratory rhythms. These disorders are currently grouped as hypersomnia with periodic breathing (HPB). Polygraphic techniques have lead to a reasonable hypothesis as to the pathophysiology of the multiple variants of HPB. Discernible causes of HPB have been attributed to both central and peripheral factors. Peripheral factors encompass those conditions relating to upper airway obstruction. An acromegalic person suffering the HPB syndrome secondary to laryngeal stenosis is described.

Electromyographic observations in the human larynx

SummaryAs can be seen, much work must yet be done with the electromyograph on the laryngeal muscles in order to obtain more information about their behaviour in health and disease.

Intrabronchial Electrocardiography A Preliminary Report

The Einthoven hypothesis implies that differences in the conductivity of body tissues are not sufficiently great to invalidate the concept that the body is a homogeneous volume conductor. Some investigators believe the lungs are sufficiently poor conductors to make questionable the concept that the body can be regarded as a homogeneous volume conductor. Intrabronchial electrocardiography is presented as a possible method for studying this problem. In ten individuals without manifest cardiac disease the distribution of potential variations in the lungs as manifested by the QRS complexes corresponded approximately and qualitatively with the distribution of the QRS complexes recorded from the body surfaces.

Laryngotracheobronchitis in pregnancy and its clinical implications

Laryngotracheobronchitis (croup) and epiglottitis are well described in the pediatric literature; however, adult upper airway disease has virtually gone unnoticed until recently. Physiologic and hormonal changes associated with pregnancy have been suggested as predisposing factors in the development of adult upper airway disease. Pregnant mothers infected with Haemophilus influenza, the most common pathogen in laryngotracheobronchitis and acute epiglottitis, have a 50% infant mortality rate. Delay in diagnosis, delay in treatment, or incorrect medical management may explain this alarming mortality rate. We have successfully treated two cases of laryngotracheobronchitis in pregnant women, which to the best of our knowledge has not been previously described in the medical literature. Diagnostic evaluation and management options particular to the pregnant patient will be discussed. These case reports serve to alert the medical community in general and otolaryngologist in particular to this serious disease entity.