Faculty Bibliography

An analysis of alcoholism-related content in the MMPI was undertaken using an alcoholic population, a psychiatric population and two normal populations. The alcoholic and psychiatric groups were drawn from facilities in the Minneapolis-St. Paul area, and the normal populations were the Hathaway Adult Group and the Mayo Clinic nonpsychiatric patient group. A derivation study and a cross-validation resulted in the identification of three item pools: 1) that discriminate alcoholics from both normals and psychiatric patients, 2) items that discriminate alcoholics from normals only, 3) items that discriminate alcoholics from psychiatric patients only. Only seven items discriminate both male and female alcoholics from both normals and psychiatric patients. These items have substantial face validity. As the core of alcoholism-related content in the MMPI, they can serve as a stem for the development of scales with more specialized purposes.

Neurilemomas of the tracheobronchial tree are exceedingly rare. In this article we report what is, to our knowledge, the 12th case--the third such case of tracheal origin. Clinical features are referable to airway obstruction and local pressure effects. The gross appearance is of an encapsulated lesion. Histologically, there is a proliferation of Schwann cells that are found in either an ordered, palisaded configuration (Antoni type A), or a disordered, loosely textured configuration (Antoni type B). The two types may coexist in a single lesion. Endoscopic removal of nonvascular tracheobronchial masses with follow-up, including periodic chest x-ray films, is advocated. Major surgery is reserved for malignant disease or benign disease not amenable to endoscopic excision.

The clinical courses of patients on the Head and Neck Service undergoing radical procedures were reviewed in retrospect. Factors that appeared to influence the courses such as preoperative radiotherapy, reduced serum albumen, and preoperative oropharyngeal obstruction were correlated with fistulization rate, flap necrosis, and other complications. The study included 105 radical procedures performed over a seven-month period. Sixty-six of these operations included laryngectomies, laryngopharyngectomies, and composite resections. The overall complication rate was 37%, with major complications accounting for 9%. A fistula rate of 20% was found in the pharyngeal group and ranged from 12% in the nonirradiated patients to 44% in the irradiated group. Thos patients with preoperative obstruction secondary to tumor bulk had a complication rate of 58%. Patients with reduced serum albumen levels had a higher complication rate of 55% compared with 35% for the group with normal albumen levels. This study suggests that preoperative replenishment of protein, particularly in the obstructed patient or in those with reduced serum albumen levels, would correlate with a more favorable clinical course.

Four patients with spastic dysphonia refractory to speech and phychiatric therapy were treated by crushing the recurrent laryngeal nerve. Vocal cord paralysis was produced in all patients. Vocal spasticity subsided in all patients. Vocal cord motion returned in four to six months. Three of four patients remained free of spasticity for a minimum of 24 months.

Fourteen case reports have been published in which "hot" nodules have been documented as carcinoma, with or without coexisting adenomas. The diagnosis of these lesions is difficult, since hot nodules usually represent benign disease. These carcinomas are not functional, but represent coexistence of a functional area or a malignant degeneration. Hot nodule carcinomas should be suspected in high-risk patients. A euthyroid, 31-year-old woman who, as a teenager, had radiotherapy for acne is reported. She was followed up with yearly scans for a hot nodule in the right lower lobe of her thyroid. When she was 36, a node was discovered in the right side of her neck, and carcinoma was suspected. Surgical excision revealed a papillary-follicular carcinoma adjacent to an adenoma with metastases to regional lymph nodes.

Electrophysiological and histological observations in guinea pig's cochleas after amikacin treatment (14 X 450 mg/kg) confirm the results obtained in a former experiment: clear, short-latency, click-evoked responses were recorded in cochleas with only very few hair cells remaining at the extreme apex. Detailed analysis of these responses strongly indicates a neural origin and confirms their low-frequency sensitivity. Careful histological observations confirm the extensive hair cell loss and the preservation of nerve fibers in the remnants of the organ of Corti and of the vestibular sense organs. These results suggest that the acoustical vibrations either stimulate the vestibular receptors or act directly or through some kind of mechano-electrical transduction on the remaining cochlear nerve fibers.