Terry L. Fry

Human papillomavirus DNA types in squamous cell carcinomas of the head and neck

Previous studies have found variable evidence suggestive of a role for human papillomavirus (HPV) in squamous cell carcinoma of the head and neck. In this study 49 cases of primary verrucous or squamous cell carcinoma from patients referred to a regional medical center were examined initially by Southern blot hybridization to detect HPV types 2, 6, 11, 13, 16, 18, and 32. Approximately 60% of carcinomas from certain head and neck sites, particularly the floor of the mouth, tongue, pharynx, piriform sinus, and larynx, were positive for episomal viral DNA of HPV-6, -11, -16, or -18. HPV DNA was found in some multiple tumors from separate sites of the same patient. Integration of viral DNA into the host cell chromosome was likely in a minority of the positive carcinomas, and no novel HPV DNA types were indicated by the hybridization analyses. Subsequently, DNA remaining from 30 of the carcinomas was examined by a more sensitive polymerase chain reaction amplification assay for DNA of HPV-6, -11, -16, and -18. Twenty-seven of the samples were positive for one or more HPV DNA types, with all positive carcinoma samples containing oncogenic HPV-16 or -18 DNAs. Almost all the patients examined were of the middle to older age group with a history of tobacco use. Although HPV infection of oral mucosa may be a frequent occurrence, a possible role for HPVs in the multifactorial etiology of head and neck carcinogenesis merits further epidemiologic investigation.

Comparisons of tracheostomy incisions in a pediatric model.

Tracheostomy in children causes approximately twice the mortality and morbidity as in the adult. The occurrence of complications correlates closely with the severity of the preoperative tracheal disease, the length of time the tracheostomy is needed, and the age of the patient. Morbidity documented in the postoperative period includes tracheal stenosis and collapsible anterior tracheal wall. The increased incidence of these problems in the pediatric patient may be related to the less rigid nature of the younger cartilage or to partial arrest of the normal tracheal growth rate, and may be aggravated by the style of tracheal incision used. Our study utilized weanling male ferrets in an effort to evaluate the possibly different response of growing, less resilient cartilage to different types of tracheal incision. Animals were randomized into three groups based on the type of incision used: inferiorly based trapdoor, vertical slit, or horizontal H. Endoscopic, radiographic, and airflow studies, as well as cross-sectional areas, were compared on all animals surviving tracheal cannulation for eight days and subsequent decannulation for seven days. Recommendations for pediatric tracheal incision are made on the basis of these studies.

Effects of laser, scalpel, and electrosurgical excision on wound contracture and graft "take".

SUMMARY Current literature recommends the use of a carbon dioxide laser for excision of lesions where minimal damage and wound contracture are desirable.5,6 The extent of tissue damage is evaluated as a correlate of percentage of split-thickness skin graft “take” following excision of full-thickness skin with scalpel, electrocutting current, or carbon dioxide laser. The poorest overall percentage “take” is apparent following laser excision, while the highest overall percentage “take” occurs following scalpel excision. Wound contracture, an inherent part of wound healing, is reportedly minimal or clinically inapparent with laser excision.5,6 On the contrary, this experimental evaluation suggests that wound contracture following laser excision is at least as great if not greater than that following other methods of excision when a split-thickness skin graft is applied to the wound bed.

Tracheal reconstruction with pedicled thyroid cartilage.

Limited areas of tracheal stenosis have been repaired with a variety of techniques. More extensive upper tracheal defects present a greater challenge with less predictable success. The following is the description of yet another technique for reconstruction of extensive upper tracheal defects. We report on the use of a muscle‐pedicled thyroid alar graft which carries its own blood supply and perichondrial covering, supplies a large, conveniently shaped graft, requires one operative site and one operative sitting, and has proven advantageous even in the compromised patient.

Orbital complications of sickle cell disease

Swelling and pain of the peri-orbital tissues in patients with sickle cell disease has been described. This has most often been ascribed to orbital apex syndrome, but there are recent reports in the literature of frontal bone infarctions compounding this syndrome. We will present a case report of a child with sickle cell disease with bilateral orbital abscesses and frontal bone infarctions. The literature pertaining to the diagnosis and treatment of the orbital complications of sickle cell disease is reviewed. We stress that intravenous antibiotics are not adequate therapy for orbital abscesses and that these must be drained surgically.

Otoscopy and Photography A New Method

A new hand-held otoscope photographic system, convenient and suitable for clinical application, is introduced. This instrument allows clear otoscopic examination in stenotic or tortuous ear canals, and photographs the subject in one procedure. The instrument consists of a rodlens optical system, a fiberoptic light source, a camera, and exchangeable speculum and a strobe light. Color photographs of tympanic membranes and middle ear pathology are presented.

Frontal sinus trephination: A new technique for office procedure

A new office technique for frontal sinus trephination is described. The procedure is simple, expedient, and inexpensive. Our experience with 16 patients suggests that this procedure is reasonably safe and, in addition, avoids the often‐seen complications of supra‐trochlear nerve injury and persistent noticeable scar.

Evaluation of otic drops on infection and healing of traumatic tympanic membrane perforations

Guinea pigs were used to compare the efficacy of three commercially available otic preparations in treating traumatic tympanic membrane perforations. The results suggest that a clear, viscous solution of low pH will significantly reduce the incidence of infection and will not retard subsequent membrane healing.

Evidence for obstructive etiology in intravenous bacterial pyelonephritis

Abstract Ultrastructural studies concerned with the initiation of experimental E. coli pyelonephritis have demonstrated that the primary pathology occurs in the proximal tubular cell mitochondria as early as 3 hr following injection with bacteria or bacteria-free toxin. Sequelae of this pathologic change resulted in sloughing of necrotic cellular debris into the tubular lumina within 6 hr and the disappearance of the intraluminal debris by 24 hr. These observations suggest that the primary pathology in the E. coli model of experimental pyelonephritis results from a bacterial toxin capable of damaging tubular cell mitochondria. Intraluminal sloughing of these necrotic cells eventuates in focal obstruction of nephrons rendering this renal segment more vulnerable to infection.