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Gastric damage from ingested acid in children
CURRENT LITERATURE
750
gical Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242.
Gastric Damage from Ingested Acid in Children. Gillis DA, Higgins G, Kennedy R, J Pediatr Surg 20:494, 1985 Two cases of acid ingestion in children are presented, and the distinction is made between acid and alkali ingestion. Strong alkalis cause immediate tissue injury with maximal damage to oropharynx and esophagus, but significant gastric effects are uncommon. In contrast, strong acids result in little oral, pharygeal, and esophageal damage. Rather, once they reach the stomach, acids may produce pylospasms and perforations and cause delayed emptying. Treatment should include fiberoptic endoscopy with antral resection or pyloroplasty when indicated.T. B. NEWLAND Reprint requests to Dr. Gillis: lzaak Walton Killam Hospital for Children, 5850 University Avenue, Halifax, Nova Scotia, B3J 3G9, Canada.
Magnetic Resonance Imagery Versus Computed Tomography. Comparison in Imaging Oral Cavity and Pharyngeal Carcinomas. Schaefer SD, Maravilla KR, Suss RA, Burns DK, Nunnally R, Merkel MA, Close LG. Arch Otolaryngol 111:730, 1985 Twenty-one patients with oral cavity and pharyngeal carcinomas were enrolled in a prospective protocol to study the diagnostic efficacy of magnetic resonance imaging (MRI) versus computed tomography (CT). CT has significantly improved the evaluation of head and neck carcinoma. However, in other head and neck applications, such as evaluation after radiotherapy, CT attenuation is decreased due to fibrosis and tissue edema even with the use of intravenous contrast material. Unlike CT, MRI distinguishes variations in the time-dependent behavior of hydrogen nuclei (relaxation), which may differ by more than an order of magnitude between tissues. These phenomena are observable by MRI without contrast-enhancing agents. The system (Diasonics MT/S) used for MRI has a superconducting magnet operating at a field strength of 0.35 tesla. Images of the oral cavity and pharynx were obtained in transaxial and coronal projections by a spin-echo technique. Computed tomography was performed with the patient’s head in the neutral position (0’ to Reid’s baseline), with either a General Electric 8800 or a Picker 1200 SX CT scanner. A split highdose intravenous infusion of contrast medium was used. Nineteen patients had squamous cell carcinomas arising from either the oral cavity or the pharynx. The remaining two patients had adenoid cystic carcinomas and adenocarcinomas involving the nasopharynx. All of the carcinomas were at least T,. The authors thought that the optimal imaging technique must clearly delineate the primary tumor and define the extent of tumor involvement. In comparing MRI with CT, the authors chose three major clinically relevant factors: conspicuity, edge definition, and limits of disease extention. In the areas evaluated, the results reflect both inherent advantages of MRI over radiology and the limitations of a new technology. Conspicuity was best with MRI, as was expected due to the variation in physical properties. Edge definition was only slightly better with MRI than with CT, and the assessment of regional extension and enlarged lymph nodes was particularly poor with MRI. The latter findings are the result of the large (7-mm) sections and the lo-mm intervals available with MRI. Base of tongue motion inter-
fered significantly with the quality of the images obtained at this site. Given these results, the authors believe that some would question the role and even the place of MRI in the head and neck as CT is firmly established as an adjunctive procedure for clinical staging and the evaluation of the occult primary tumor, as well as an assessment tool for tumor therapy. Nevertheless, they believe that with improvements MRI will emerge as the preferred form of imaging iu the not-too-distant future.-DONALD M. PKIMLEY Reprint requests to Dr. Schaefer: Department of Otorhinolaryngology, Southwestern Medical School, University of Texas Health Science Center, 5323 Harry Hines Boulevard, Dallas, TX 75235. New Test Series for the Functional
Cavity Cancer. Teichgraeber Head Neck Surg 8:9, 1985
Evaluation of Oral J, Bowman J, Goepfert H.
This article details an inexpensive and reproducible series of tests to assess through different modalities the oral cavity function and general health of patients under treatment for oral cancer. The parameters tested included speech, swallowing, taste, pain, employability, saliva control, dental health, maintenance of weight, and daily activity level. Based on the results of testing, scores were assigned and correlated with the site and stage of the tumor, the treatment mode, and the type of reconstruction if surgery had been performed. Fifty-five patients were evaluated to check the feasibility of this type of testing. The test series is being used for a large prospective study in which the authors are attempting to uncover correlations between various oral cancer treatments and reconstructive techniques and the quality of life after treatment. It is anticipated that the results will provide guidelines for the treatment of oral malignancies-JAMES R. HUPP Reprint requests to Dr. Goepfert: Department of Head and Neck Surgery, Box 69, J. D. Anderson Hospital and Tumor Institute, 6723 Bertner Avenue, Houston, TX 77030.
Functional Oromandibular Reconstruction with the Microvascular Composite Groin Flap. Sahbian A, Rappaport I, Allison G. Plast Reconstr Surg 76:819, 1985 The microvascular osteocutaneous groin flap has been useful in the replacement of tissue following extirpation of oromandibular structures. Enhanced blood supply to these flaps has made it easier to replace bone and soft tissue and to minimize complications in irradiated fields. However, functional results are poor, particularly in patients undergoing combined glossectomy and arch resection, With the objective of improving function, microvascular osteocutaneous groin flaps were used for oromandibular reconstruction in 10 patients. The flap was based on the superficial and deep circumflex iliac vessels for optimal positioning of the bone and contouring of the skin. Six of the ten patients had good functional results. These patients were able to tolerate a soft diet without aspiration and to speak intelligibly. They had good mandibular excursion, lip contaction, with no drooling or salivary pooling, and they retained the ability to suck. Cineradiographic studies to evaluate swallowing in selected patients showed that the shape of the intraoral flap and the location of the bone graft played an important role in proper swallowing and preventing aspiration.MONROEE. HARRIS
750
gical Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242.
Gastric Damage from Ingested Acid in Children. Gillis DA, Higgins G, Kennedy R, J Pediatr Surg 20:494, 1985 Two cases of acid ingestion in children are presented, and the distinction is made between acid and alkali ingestion. Strong alkalis cause immediate tissue injury with maximal damage to oropharynx and esophagus, but significant gastric effects are uncommon. In contrast, strong acids result in little oral, pharygeal, and esophageal damage. Rather, once they reach the stomach, acids may produce pylospasms and perforations and cause delayed emptying. Treatment should include fiberoptic endoscopy with antral resection or pyloroplasty when indicated.T. B. NEWLAND Reprint requests to Dr. Gillis: lzaak Walton Killam Hospital for Children, 5850 University Avenue, Halifax, Nova Scotia, B3J 3G9, Canada.
Magnetic Resonance Imagery Versus Computed Tomography. Comparison in Imaging Oral Cavity and Pharyngeal Carcinomas. Schaefer SD, Maravilla KR, Suss RA, Burns DK, Nunnally R, Merkel MA, Close LG. Arch Otolaryngol 111:730, 1985 Twenty-one patients with oral cavity and pharyngeal carcinomas were enrolled in a prospective protocol to study the diagnostic efficacy of magnetic resonance imaging (MRI) versus computed tomography (CT). CT has significantly improved the evaluation of head and neck carcinoma. However, in other head and neck applications, such as evaluation after radiotherapy, CT attenuation is decreased due to fibrosis and tissue edema even with the use of intravenous contrast material. Unlike CT, MRI distinguishes variations in the time-dependent behavior of hydrogen nuclei (relaxation), which may differ by more than an order of magnitude between tissues. These phenomena are observable by MRI without contrast-enhancing agents. The system (Diasonics MT/S) used for MRI has a superconducting magnet operating at a field strength of 0.35 tesla. Images of the oral cavity and pharynx were obtained in transaxial and coronal projections by a spin-echo technique. Computed tomography was performed with the patient’s head in the neutral position (0’ to Reid’s baseline), with either a General Electric 8800 or a Picker 1200 SX CT scanner. A split highdose intravenous infusion of contrast medium was used. Nineteen patients had squamous cell carcinomas arising from either the oral cavity or the pharynx. The remaining two patients had adenoid cystic carcinomas and adenocarcinomas involving the nasopharynx. All of the carcinomas were at least T,. The authors thought that the optimal imaging technique must clearly delineate the primary tumor and define the extent of tumor involvement. In comparing MRI with CT, the authors chose three major clinically relevant factors: conspicuity, edge definition, and limits of disease extention. In the areas evaluated, the results reflect both inherent advantages of MRI over radiology and the limitations of a new technology. Conspicuity was best with MRI, as was expected due to the variation in physical properties. Edge definition was only slightly better with MRI than with CT, and the assessment of regional extension and enlarged lymph nodes was particularly poor with MRI. The latter findings are the result of the large (7-mm) sections and the lo-mm intervals available with MRI. Base of tongue motion inter-
fered significantly with the quality of the images obtained at this site. Given these results, the authors believe that some would question the role and even the place of MRI in the head and neck as CT is firmly established as an adjunctive procedure for clinical staging and the evaluation of the occult primary tumor, as well as an assessment tool for tumor therapy. Nevertheless, they believe that with improvements MRI will emerge as the preferred form of imaging iu the not-too-distant future.-DONALD M. PKIMLEY Reprint requests to Dr. Schaefer: Department of Otorhinolaryngology, Southwestern Medical School, University of Texas Health Science Center, 5323 Harry Hines Boulevard, Dallas, TX 75235. New Test Series for the Functional
Cavity Cancer. Teichgraeber Head Neck Surg 8:9, 1985
Evaluation of Oral J, Bowman J, Goepfert H.
This article details an inexpensive and reproducible series of tests to assess through different modalities the oral cavity function and general health of patients under treatment for oral cancer. The parameters tested included speech, swallowing, taste, pain, employability, saliva control, dental health, maintenance of weight, and daily activity level. Based on the results of testing, scores were assigned and correlated with the site and stage of the tumor, the treatment mode, and the type of reconstruction if surgery had been performed. Fifty-five patients were evaluated to check the feasibility of this type of testing. The test series is being used for a large prospective study in which the authors are attempting to uncover correlations between various oral cancer treatments and reconstructive techniques and the quality of life after treatment. It is anticipated that the results will provide guidelines for the treatment of oral malignancies-JAMES R. HUPP Reprint requests to Dr. Goepfert: Department of Head and Neck Surgery, Box 69, J. D. Anderson Hospital and Tumor Institute, 6723 Bertner Avenue, Houston, TX 77030.
Functional Oromandibular Reconstruction with the Microvascular Composite Groin Flap. Sahbian A, Rappaport I, Allison G. Plast Reconstr Surg 76:819, 1985 The microvascular osteocutaneous groin flap has been useful in the replacement of tissue following extirpation of oromandibular structures. Enhanced blood supply to these flaps has made it easier to replace bone and soft tissue and to minimize complications in irradiated fields. However, functional results are poor, particularly in patients undergoing combined glossectomy and arch resection, With the objective of improving function, microvascular osteocutaneous groin flaps were used for oromandibular reconstruction in 10 patients. The flap was based on the superficial and deep circumflex iliac vessels for optimal positioning of the bone and contouring of the skin. Six of the ten patients had good functional results. These patients were able to tolerate a soft diet without aspiration and to speak intelligibly. They had good mandibular excursion, lip contaction, with no drooling or salivary pooling, and they retained the ability to suck. Cineradiographic studies to evaluate swallowing in selected patients showed that the shape of the intraoral flap and the location of the bone graft played an important role in proper swallowing and preventing aspiration.MONROEE. HARRIS