Faculty Bibliography

Congenital saccular cysts of the larynx are unusual lesions that commonly present with respiratory obstruction in infants and children. The saccular cyst may result from an atresia of the laryngeal saccule orifice or may represent the retention of mucus in the collecting ducts of submucosal glands located around the ventricle. Traditionally, the treatment of the lesions has been endoscopic unroofing or marsupialization. Frequently, this modality requires multiple procedures as well as concomitant tracheotomy. There also have been reports of acquired subglottic stenosis. We have found that removal of the recurrent saccular cyst can be achieved relatively safely and effectively via a lateral cervical approach to the thyrohyoid membrane. We review our experience with four patients with congenital saccular cysts and detail the evaluation and surgical management of these lesions

A retrospective analysis was performed on 103 pediatric patients, less than 5 years of age, undergoing tracheotomy at New York Hospital between 1980 and 1990. Charts were reviewed with respect to primary diagnosis, indication for tracheotomy, duration of the tracheotomy, complication rate and mortality rate. Approximately 62% of the tracheotomies were performed in patients less than 12 months of age, with the most common indication being an acquired or congenital airway abnormality. The number of patients receiving tracheotomies for neurological disorders, however, increased more than threefold over the course of this review. Approximately one-third of the patients experienced immediate, early or delayed complications. There was a significant correlation between the complication rate and weight at the time of the tracheotomy as well as the degree of prematurity of the child. Over one half of the infants under 2000 g suffered complications. A mortality rate of 2.9% was noted in our study with mucous plugging of the tracheotomy being the most common etiology of death

We attempted to define the minimum blood volume and bacterial concentration required to obtain a positive blood culture with the use of placental blood and an in vitro technique. Known amounts of either Escherichia coli or group B beta-hemolytic streptococci were added to heparinized placental blood specimens. Blood samples of 0.25, 0.5, and 1.0 ml containing bacteria were inoculated into 30 ml of a commercially available broth culture medium, incubated for 24 hours, and examined for bacterial growth. Samples of at least 0.25 ml blood containing more than 10 colony-forming units of bacteria per milliliter resulted in a positive blood culture for 131 of 132 samples. On the basis of these data, we suggest that if 0.25 ml of blood is sampled and the specimen contains more than 10 colony-forming units per milliliter of E. coli or group B beta-hemolytic streptococci, the blood culture is almost certain to be positive

BACKGROUND. Not every patient with Kaposi's sarcoma (KS) has acquired immunodeficiency syndrome (AIDS). The 'classic' form of KS is rare, and is associated with an indolent course. It is very distinct from AIDS-associated KS in which oral involvement is common and may be the initial presenting feature of this disease. Two other types of KS are recognized, the African and renal transplant-associated, which also are rarely associated with oral involvement. METHODS. We present the case of a 76-year-old man of Mediterranean ancestry who was found to have a biopsy-proven classical KS lesion of the hard palate. The patient was followed by the Radiation Therapy and Otolaryngology Services during and after his treatment. A review of the literature was also conducted. RESULTS. Radiotherapy was ineffective at a dose considered 'standard' for KS in AIDS patients (1,500 cGy), but was effective when continued to 4,800 cGy. A 24-month follow-up showed no evidence of recurrence in the oral cavity. CONCLUSIONS. KS of the oral cavity, is almost always associated with AIDS in the United States, However, it can occur in any of the four types of KS. Although this neoplasm is typically highly radiosensitive, the treatment for each patient needs to be individualized

Cochlear implant surgery by a group of experienced surgeons proceeded without major complications. Computed tomography scans tended to underestimate cochlear obstruction, but a drill-out was infrequently required if the scan was apparently nounal

A theoretical framework for the segmental component of speech production is outlined and some preliminary supporting data are reviewed. According to the framework, articulatory movements are programmed to achieve sequences of goals that are defined in terms of articulatory and acoustic parameters. The goals are correlates of distinctive features. Some feature correlates are determined by quantal (non-linear) relations between articulation and sound. Goals may also be influenced by other principles, such as a compromise between sufficient perceptual contrast and economy of articulatory effort, which leads to the prediction that the goal definitions correspond to regions (as opposed to points) in acoustic and articulatory space. Thus the goals are characterized by some parameter variation, which is possible partly because listeners can understand variable speech. Before utterances are produced, goal specifications are modified by prosodic influences and reduction. The sequence of modified goal specifications is converted to smooth, appropriately-timed articulatory movements by the speech motor control system. This control and the resulting kinematics are constrained in part by the biomechanical properties of the articulators. To help keep acoustic variability within perceptually-acceptable limits, speech motor control mechanisms may include a strategy by which different parts of the vocal-tract area function are adjusted in a complementary (''motor equivalent'') manner. The strategy takes advantage of the fact that for some sounds, a similar acoustic transfer function can be achieved with somewhat different area functions. The existence of such a strategy and the idea that speech motor programming is based in part on acoustic goals are supported by data that show trading relations between lip rounding and tongue-body raising in production of the vowel /u/. $$: