Rochester Rehabilitation Center

Thirty-six patients with a total of 50 symptomatic tailor's bunions were evaluated clinically, radiographically, and subjectively, both before and after a distal oblique osteotomy procedure was performed. Thirty-four of 36 patients were satisfied with pain relief. Radiographic measurements derived from this study were consistent with those of other studies. Avascular necrosis, nonunions, or neuroma formation were not encountered in this study. The significant advantages of this procedure are its simplicity, safety, and predictability. The procedure does not require internal fixation or postoperative immobilization.

From January, 1962, through December, 1973, 1,084 patients with cancer of the intrinsic larynx were treated at the Mayo Clinic. Of the 1,084 patients, 136 were retreated after radiation therapy failed to cure their cancer (105 glottic, 30 supraglottic, and one subglottic cancers). Recurrence of glottic cancer was generally recognized later than recurrences in the supraglottic area; likewise, glottic cancers were more advanced at recurrence than supraglottic growths. When feasible, conservation surgery was carried out on both glottic and supraglottic growths. Unfortunately, many growths were too advanced for conservation surgery by the time recurrence was recognized. The concept of "radiate-and-watch" for early glottic and supraglottic cancers is designed to save larynges. The concept is not supported by this study.

The need for additional data regarding the behavior of carcinomas of the supraglottic larynx was recognized during attempts to identify candidates for supraglottic laryngectomy. The crux of the matter was whether supraglottic carcinomas remain confined at the supraglottic larynx. If some do not, can these exceptions be detected preoperatively? Information gained from whole-organ study of 40 larynges with such tumors showed that most tumors do remain confined to the supraglottic larynx; however, there are exceptions, and these are usually high-grade tumors. Preoperative biopsy demonstrating undifferentiation in a tumor suggests a potential for atypical behavior. Patients with these high-grade lesions are not candidates for supraglottic laryngectomy. Fortunately, most supraglottic carcinomas are well-differentiated, behave in a typical manner, and fulfill the expectations gained from the preoperative mucosal appearance. Supraglottic laryngectomy is, therefore, feasible and successful in carefully selected candidates. The conclusions of this study are the following: 1. Most supraglottic cancers behave as expected, being typically well-differentiated tumors that remain confined to the supraglottic larynx. 2. Exceptions to such behavior are exemplified by tumors manifesting submucosal extension some distance away from the main tumor mass, tumors invading the thyroid cartilage, second primaries, and tumors disseminating emboli away from the main tumor. 3. Present preoperative diagnostic measures still fail to detect tumors with atypical behavior. Subsequent supraglottic laryngectomy in patients with such tumors would, therefore, leave residual tumor. 4. Carcinomas exhibiting atypical behavior are characteristically undifferentiated and aggressive. 5. The epiglottis and pre-epiglottic space are easily invaded by supraglottic cancer. The pre-epiglottic space is removed during either supraglottic or total laryngectomy. 6. The thyroid cartilage is an excellent barrier to the spread of supraglottic cancers. Tumors that invade it penetrate the anterior commissure first. 7. The pitfalls in the selection of candidates for supraglottic laryngectomy are assessment problems in which the tumor mass makes it difficult to see its full mucosal extent. Inadequate biopsy may also fail to detect a tumor. 8. In the preoperative assessment of a patient with supraglottic carcinoma, supraglottic laryngectomy is contraindicated if the biopsy does show high-grade differentiation and if the tumor is situated near the petiole. 9. Undetected extension submucosally to the level of the glottis will result in some failures with conservation surgery of the larynx.

Abstract A review of 52 recent cases of Wegener's granulomatosis has clarified the clinical manifestations and has emphasized the otolaryngologist's role in its early diagnosis. All the cases satisfied the currently accepted criteria for the condition: the presence of primary necrotizing vasculitis in a patient with a typical clinical course. Among the 52 patients, 31 patients had nasal lesions. The typical manifestation was persistent nasal obstruction in a middle‐aged patient with no history of nasal disorder. In the early stages, intranasal examination may reveal only diffuse nasal mucosal swelling, without tissue destruction. Systemic symptoms are malaise, night sweats, intermittent pyrexia, and migratory arthralgias; an abnormally high sedimentation rate is also frequent. Later, the typical nasal findings are diffuse destruction of the mucosa and foul‐smelling crusts. The tissue underlying the crusts is extremely friable. Perforations of the nasal septum are also common. Adequate biopsy of representative tissue is important. The condition is treatable; currently, corticosteroids with or without cyclophosphamide are being used. Of the 52 patients, 31 are alive; 10 are dead, and current information is unavailable on 11 patients.Polymorphic reticulosis (PMR, lethal midline granuloma, or malignant midline reticulosis) was noted in 16 other patients during the same period. Differentiation between PMR and Wegener's granulomatosis is important because, although they can resemble each other clinically, they are morphologically distinct and respond to different forms of therapy (Wegener's granulomatosis to immunosuppressive drugs and PMR to irradiation).The otolaryngologist has an important role in the early diagnosis of Wegener's granulomatosis because of the high incidence of nasal involvement and because of the variations in clinical manifestations, which depend on the stage of the disease.

Abstract The study involved 42 healthy adult guinea pigs placed into two major groups. In group A, only histologic studies were performed after obliteration of the right vestibular aqueduct, the cochlear aqueduct, or both the vestibular and cochlear aqueducts. In group B, hearing changes were monitored by repeated determination of averaged temporal response thresholds after the same obliterative operations as in group A. At the conclusion of the experiments, histologic studies of temporal bone were performed and hearing changes were correlated with the severity of disease found in the inner ear.Histologic examination of 32 temporal bones from animals in which the vestibular aqueduct or both the vestibular and cochlear aqueducts were obliterated consistently demonstrated endolymphatic hydrops. The endolymphatic hydrops was usually progressive, and its severity was proportional to the length of time from the operation. Serial determination of averaged temporal response thresholds in 18 guinea pigs after these operations demonstrated a progressive deterioration in thresholds. The hearing loss was greater at the lower frequencies. The audiometric changes correlated positively with the severity of endolymphatic hydrops. No significant audiometric or temporal bone histologic changes were found after obliteration of the cochlear aqueduct.

Abstract Several clinically different benign lesions can arise from the saccular appendage. The precise lesion at a given time depends on:1.the size of the saccule;2.whether free communication is possible between the appendage and the laryngeal lumen; and3.the presence or absence of inflammation. These lesions represent a spectrum of lesions in that clinical manifestations can vary from those of one type of lesion to another.A tiny saccule of only a few millimeters in length, with its lumen isolated from the ventricle, presents as a cyst of the anterior ventricle. A larger appendage, also closed from the laryngeal lumen, presents as a cyst of the lateral larynx, the so‐called congenital cyst or lateral saccular cyst. This same cyst can extend into the neck through the thyrohyoid membrane. This cyst can be seen at any age but is most common in the newborn and infant.An air sac or cyst (laryngocele) also can present as a small lesion of the anterior ventricle or as a larger sac within the lateral intrinsic larynx or can extend into the neck by way of the thyrohyoid membrane. Whether the growth is a mucus‐containing cyst or an air sac depends upon whether there is a communication with the air column of the larynx at the ventricle; a laryngopyocele is an infected air sac.Recognition of the developmental spectrum of saccular lesions should simplify terminology.

The LaryngoscopeVolume 81, Issue 8 p. 1208-1222 Article Relapsing polychondritis: Audiovestibular manifestations† D. Thane R. Cody M.D., Corresponding Author D. Thane R. Cody M.D. Rochester, Minn.Mayo Clinic, Rochester, Minn. 55901Search for more papers by this authorDonald A. Sones M.D., Donald A. Sones M.D. Rochester, Minn.Search for more papers by this author D. Thane R. Cody M.D., Corresponding Author D. Thane R. Cody M.D. Rochester, Minn.Mayo Clinic, Rochester, Minn. 55901Search for more papers by this authorDonald A. Sones M.D., Donald A. Sones M.D. Rochester, Minn.Search for more papers by this author First published: August 1971 https://doi.org/10.1288/00005537-197108000-00004Citations: 105 † Presented at the Meeting of the Middle Section, American Laryngological, Rhinological and Otological Society, Inc., Nassau, Bahamas, January 19, 1971. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume81, Issue8August 1971Pages 1208-1222 RelatedInformation

Journal Article Polyneuropathy Associated with Hypothyroidism Get access Peter J. Dyck, M.D., Peter J. Dyck, M.D. Rochester, Minn. Search for other works by this author on: Oxford Academic PubMed Google Scholar Edward H. Lambert, M.D. Edward H. Lambert, M.D. Rochester, Minn. Search for other works by this author on: Oxford Academic PubMed Google Scholar Journal of Neuropathology & Experimental Neurology, Volume 29, Issue 4, October 1970, Pages 631–658, https://doi.org/10.1097/00005072-197010000-00008 Published: 01 October 1970