Faculty Bibliography

Meibomian gland carcinomas of the eyelid are rare neoplasms, accounting for less than 1% of all eyelid tumors. They usually mimic chalazia and undergo repeated curettage before a definitive diagnosis is made. Although they are relatively slow growing tumors they behave in an aggressive manner, frequently metastasizing to regional lymph nodes. Approximately 50% of the patients who develop metastasis to lymph nodes of the neck will survive five years. We present a case of meibomian gland carcinoma with preauricular lymph node metastasis, treated with orbital exenteration, superficial parotidectomy, and radical neck dissection.

Internal jugular vein thrombosis is a vascular disorder that is easily overlooked or misdiagnosed. It occurs in a variety of clinical settings which disrupt normal blood flow through the internal jugular vein. Intravenous drug abusers represent a high risk group in this study. Diagnosis is readily made by computed tomography. Seven patients are presented, with discussion of the pathogenesis, clinical findings, radiologic features, potential complications, and treatment rationale

Since December 1980, over 3000 cases of acquired immunodeficiency syndrome (AIDS) have been reported. The charts of 102 patients admitted to the New York University Medical Center with a diagnosis of AIDS were reviewed with particular emphasis on presenting signs, symptoms, and laboratory values. Symptoms tended to be nonspecific and most often resembled those of an upper respiratory infection. Over 71% of the patients presented with at least two of the following four signs: diffuse adenopathy, oral and facial lesions consistent with Kaposi's sarcoma, white oral lesions, and anergy. Laboratory findings included leukopenia, increased erythrocyte sedimentation rate, thrombocytopenia, and anemia. The in-hospital mortality rate was 26%. The current status of our knowledge concerning AIDS is reviewed and discussed. The frequency and types of presenting signs and symptoms in the head and neck are reported to alert the otolaryngologic community to this entity

During 1984, six patients have been implanted with a 22-channel cochlear prosthesis. The device features a programmable wearable speech processor using a speech feature encoding strategy. A strict clinical protocol was followed, and no patients have been lost to follow-up. All patients are regular users of the device and have shown a restoration of hearing sensation in response to acoustic stimuli. Pure tone averages ranged from 20 to 47 dB HL and speech detection thresholds varied from 15 to 32.5 dB HL. All patients have shown a recognition of a large variety of environmental sounds, and an improvement in speech recognition ability when the device is used in conjunction with lipreading. Speech reception thresholds using spondee words without lipreading were obtained in three patients at levels of 27.5 to 55 dB HL and one patient had an open-set speech discrimination score (w-22 word list) of 42% without lipreading. In addition, two of the patients show an ability to have limited interactive conversation without the use of lipreading

A total of 224 recent isolates of Mycobacterium tuberculosis from 163 patients selected to have multidrug resistance were tested against streptomycin (SM), isoniazid, rifampin, and ethambutol (EMB) by the rapid radiometric BACTEC method and two conventional proportion methods: the World Health Organization (WHO) method, using Lowenstein-Jensen medium; and the Veterans Administration reference laboratory for mycobacteria (VA) method, using Middlebrook 7H10 agar medium. The results were compared, focusing on the concentrations of the drugs in all three methods. Among the four drugs tested, most of the discrepancies in measured activity were observed with SM and EMB, generally because of differences in the drug concentrations used by the three methods. A 4-micrograms amount of SM in the BACTEC method was found to be slightly less active than 10 micrograms in the VA method and significantly more active than 4 micrograms of dihydrostreptomycin in the WHO method. With EMB, 2.5 micrograms in BACTEC was similar to 5 micrograms in the VA method and 2 micrograms in the WHO method, while 10 micrograms in the BACTEC method was found to be more active than 10 and 2 micrograms in the VA and WHO methods, respectively. To attain close agreement, drug concentrations used in the BACTEC method should be carefully selected when a comparison is to be made with any conventional method employed in a laboratory. Standardization of in vitro susceptibility testing is greatly needed to achieve uniformity among the test methods used to evaluate tuberculosis therapeutics.

Antibodies to the clonally unique variable-region determinants (idiotype) of the antigen-specific alpha beta heterodimeric receptor of a clone of cytotoxic T cells (CTLs) were shown previously to render diverse cells, regardless of their own surface antigens, susceptible to lysis by that clone of CTLs. To extend these findings, we have sought to develop a general means for targeting cells for destruction by any CTL, without regard to its alpha beta idiotype and specificity for antigen. We explored the use of heteroantibody duplexes formed by joining covalently an antibody to the T3 complex (anti-T3), which is associated with the alpha beta receptors on all human mature T cells, and a second antibody, specific for an antigen on the intended target cell. The second antibody selected in this study was specific for the idiotype (Id) of the surface immunoglobulin of a human B-lymphoma (anti-Ig Id). In the presence of the anti-T3/anti-Ig Id heteroantibody duplex the B-lymphoma cells were lysed by a clone of human T8+ CTLs (of unrelated specificity) but not by a noncytotoxic clone of human T4+ helper T cells, and lysis by the CTLs was specifically blocked by the uncoupled anti-T3 or the uncoupled anti-Ig Id antibodies. The extent of the heteroantibody-dependent cytolysis depended both on the heteroantibody concentration and on whether the intended target cells or the CTL effectors were initially preincubated with the heteroantibody. Under optimal conditions, heteroantibody-dependent lysis of the surrogate target (B-lymphoma) cells by the CTLs compared favorably with lysis of their natural target cells by the same CTLs. Overall, our findings suggest that heteroantibody duplexes containing anti-T3 antibody may be capable of targeting selected cells, such as tumor cells, for destruction in vivo by the body's CTLs.

Principles of osteosynthesis utilizing dynamic compression plating have been used in immediate and delayed mandibular reconstruction in five patients. Intermaxillary fixation was not used. Follow-up ranged from eight to 14 months. Four of five patients have viable bone grafts at the present time. One bone graft has been lost due to infection. We feel mandibular reconstruction based on principles of osteosynthesis helps to rapidly restore cosmesis and function with minimal morbidity

Cricopharyngeal myotomy is an effective procedure for the treatment of swallowing disorders due to dysfunction of the upper esophageal sphincter and pharyngeal musculature. Eight patients with documented pharyngeal and sphincteric dysfunction have undergone myotomies with significant improvement in swallowing associated with restoration of oral feeding without aspiration in 5, while 3 patients have not improved. The preoperative work-up and evaluation is discussed as well as criteria that may identify those patients most likely to benefit from this treatment

A rare case of mixed ependymoma and astrocytoma of the cerebellopontine angle is reported. Its clinical presentation, characteristics on evaluation, and prognosis are compared with those of the acoustic neuroma and glioma. The central form of von Recklinghausen's disease and familial multiple lipomatosis as it applies to the patient is also discussed

The longitudinal stability of personality was investigated in a group of several hundred adults who were rated by themselves, their marriage partners, and their acquaintances in 1935-1938 and by themselves and their marriage partners in 1954-1955. For both men and women, there were very similar factorial structures in all five sources of ratings. Individual differences in neuroticism, social extraversion, and impulse control had reasonably high levels of longitudinal stability over a 19-year period. Both the synchronic and diachronic correlations converged across methods and discriminated among traits. Self-report personality inventory data available in 1935-1938 and 1954-1955 provided corroborating evidence of the longitudinal and methodological robustness of personality traits. In data gathered on the same panel in 1980-1981, the questionnaire and the life history correlates of neuroticism and social extraversion displayed patterns indicative of temporal stability, methodological convergence, and discrimination among constructs. The data of this longitudinal study carried out over five decades strongly indicate that there is a set of personality traits that are generalizable across methods of assessment and are stable throughout adulthood.