Although the surgical procedure for the treatment of cerebrospinal fluid leakagea ssociated with trauma has been mainly performed by the intracranial approach, it is necessary to treat such injuries by the rhinological approach in cases of injury involving the nose and/or paranasal sinuses. The author describes 12 cases of cerebrospinal fluid leakage treated surgically through the nose and paranasal sinuses. Spontaneous discontinuance of the cerebrospinal fluid leakage is often succeeded by late complications such as mucocele or pyocele, due to obstruction of the natural ostium of the sinuses. The author stresses the importance of rhinological approach to the cerebrospinal leakage through the paranasal sinuses so as to treat the injury of the nose and paranasal sinuses together with the repair of the injured dura mater.
Three cases of retropharyngeal abscess which caused respitrory obstruction are reported. Two of them 3-and 9-month-old infants had acute upper respiratory tract infection and the other case, a 38-year-old male, had extension of tuberculous osteomyelitis of the fourth cervical vertebra. It is important that the external cervical incision and drainage of the abscesses is accomplished under general endotracheal anesthesia in order to afford the surgeon an opportunity to achieve adequate drainage and at the same time to protect the tracheobronchial tree from aspiration of pus in case of inadvertent rupture of the abscess. Nasotracheal intubation is better than tracheotomy as a means of airway maintenance in cases with retropharyngeal abscess in infants who often present the problem of difficulty in decannulation.
The etiology of chronic sinusitis remains unknown and controversy still prevails concerning the value of surgical treatment of chronic sinusitis in children. Chronic sinusitis is not simply a chronicity of acute inflammation of the mucous membrane of the paranasal sinuses but various intrinsic and extrinsic factors are believed to be involved in the pathogenesis of the disease. The authors reviewed the postoperative healing patterns of sinusectomy in children and studied the effects of preoperative pathology, subjective and objective findings and type of surgery performed upon the healing process of the operated cases and discuss the merits and costs of surgical treatment of chronic sinusitis in children.
Many investigators tried to find a specific scanning agent for the diagnosis of malignant tumors. However, as yet, success has been limited. Recently, radioisotopic elements such as 131I fi brinogen, 97Ga citrate and 99mTc compound have been introduced to nuclear medicine. Maeda et al. reported that 57Co Bleomycin can be used as a radioisotopic scanning agent for diagnosis of a variety of human cancers. Since this discovery, the application of this method to Otolaryngology has been investigated in our hospital. 57Co Bleomycin was administered to sixteen patients with tumors which were histologically diagnosed as malignant, and was compared with 169Yb citrate injections. In arterial infusion cases, 57Co Bleomycin 200 Ci was injected into a polyethylene tube, which was instered into the A. tempolaris superficialis. 500 Ci was administered intravenously. Twenty-four hours after injection, scintiphotographys were taken with a scintillation camera (PHO GAMMA HP Nuclear Chicago.) Results were:(1) Scintiphotography revealed positive results in thirteen out of sixteen cases; ten of these were classified as squamous cell carcinoma. The remaining three were classified as malignant lymphoma, lymphoepithelial carcinoma and plasma cell cytoma. (2) With the administration of 57Co Bleomycin, high radioactivity was found only in tumor tissue. Tumor localization by this agent coincided with X-ray photo findings and surgery findings. The tumor forms and inner construction details were revealed more clearly by 57Co Bleomycin than by 169Yb citrate.
Neuroleptanalgesia was developed by De Castro and Mundeleer in 1959 in anattempt to provide surgical patients with psychic calm and freedom from pain during the operation. Our recent experiences with the neuroleptanalgesia applied to the surgical patients in otolaryngology are reported. Anesthetized patients during the operation were carefully monitored and the principal procedures of neuroleptanalgesia are discussed.